Abstract：
BACKGROUND: The relationship between venous thromboembolism (VTE) and solid malignancy has been established over the decades. With rising projected rates of bladder cancer (BCa) worldwide as well as increasing number of patients experiencing BCa and VTE, our aim is to assess the impact of a preoperative VTE diagnosis on perioperative outcomes and health-care costs in BCa cases undergoing radical cystectomy (RC).
METHODS: Patients ≥18 years of age with BCa diagnosis and undergoing open or minimally invasive (MIS) RC were identified in the Merative™ Marketscan® Research Databases between 2007 and 2021. The association of previous VTE history with 90-day complication rates, postoperative VTE events, rehospitalization, and total hospital costs (2021 USA dollars) was determined by multivariable logistic regression modeling adjusted for patient and perioperative confounders. Sensitivity analysis on VTE degree of severity (i.e., pulmonary embolism [PE] and/or peripheral deep venous thrombosis [DVT]) was also examined.
RESULTS: Out of 8759 RC procedures, 743 (8.48%) had a previous positive history for any VTE including 245 (32.97%) PE, 339 (45.63%) DVT and 159 (21.40%) superficial VTE. Overall, history of VTE before RC was strongly associated with almost any worse postoperative outcomes including higher risk for any and apparatus-specific 90-days postoperative complications (odds ratio [OR]: 1.21, 95% CI, 1.02-1.44). Subsequent incidence of new VTE events (OR: 7.02, 95% CI: 5.93-8.31), rehospitalization (OR: 1.25, 95% CI: 1.06-1.48), other than home/self-care discharge status (OR: 1.53, 95% CI: 1.28-1.82), and higher health-care costs related to the RC procedure (OR: 1.43, 95% CI: 1.22-1.68) were significantly associated with a history of VTE.
CONCLUSIONS: Preoperative VTE in patients undergoing RC significantly increases morbidity, post-procedure VTE events, hospital length of stay, rehospitalizations, and increased hospital costs. These findings may help during the BCa counseling on risks of surgery and hopefully improve our ability to mitigate such risks.
METHODS: Patients ≥18 years of age with BCa diagnosis and undergoing open or minimally invasive (MIS) RC were identified in the Merative™ Marketscan® Research Databases between 2007 and 2021. The association of previous VTE history with 90-day complication rates, postoperative VTE events, rehospitalization, and total hospital costs (2021 USA dollars) was determined by multivariable logistic regression modeling adjusted for patient and perioperative confounders. Sensitivity analysis on VTE degree of severity (i.e., pulmonary embolism [PE] and/or peripheral deep venous thrombosis [DVT]) was also examined.
RESULTS: Out of 8759 RC procedures, 743 (8.48%) had a previous positive history for any VTE including 245 (32.97%) PE, 339 (45.63%) DVT and 159 (21.40%) superficial VTE. Overall, history of VTE before RC was strongly associated with almost any worse postoperative outcomes including higher risk for any and apparatus-specific 90-days postoperative complications (odds ratio [OR]: 1.21, 95% CI, 1.02-1.44). Subsequent incidence of new VTE events (OR: 7.02, 95% CI: 5.93-8.31), rehospitalization (OR: 1.25, 95% CI: 1.06-1.48), other than home/self-care discharge status (OR: 1.53, 95% CI: 1.28-1.82), and higher health-care costs related to the RC procedure (OR: 1.43, 95% CI: 1.22-1.68) were significantly associated with a history of VTE.
CONCLUSIONS: Preoperative VTE in patients undergoing RC significantly increases morbidity, post-procedure VTE events, hospital length of stay, rehospitalizations, and increased hospital costs. These findings may help during the BCa counseling on risks of surgery and hopefully improve our ability to mitigate such risks.
摘要：
背景：静脉血栓栓塞（VTE）与实体恶性肿瘤之间的关系已经建立了数十年。随着全球膀胱癌（BCa）发病率的上升以及经历BCa和VTE的患者数量的增加，我们的目的是评估术前VTE诊断对行根治性膀胱切除术(RC)的BCa患者围手术期结局和医疗费用的影响.
方法：在2007年至2021年期间，Merative™Marketscan®研究数据库中确定了年龄≥18岁的BCa诊断并接受开放或微创（MIS）RC的患者。既往VTE病史与90天并发症发生率的相关性，术后VTE事件,再住院,和总住院费用(2021美元)通过多变量逻辑回归模型确定,校正了患者和围手术期的混杂因素.VTE严重程度的敏感性分析(即，还检查了肺栓塞[PE]和/或外周深静脉血栓形成[DVT]）。
结果：在8759个RC程序中，743（8.48％）有任何VTE的阳性病史，包括245（32.97％）PE，339（45.63%）DVT和159（21.40%）浅表VTE。总的来说,RC前的VTE病史与几乎所有更差的术后结局密切相关,包括任何和特定于器械的术后90天并发症的高风险(比值比[OR]:1.21,95%CI,1.02~1.44).新的VTE事件的后续发生率（OR：7.02，95％CI：5.93-8.31），再住院（OR：1.25，95%CI：1.06-1.48），除家庭/自理出院状态外（OR：1.53，95%CI：1.28-1.82），与RC手术相关的较高医疗保健费用(OR:1.43,95%CI:1.22-1.68)与VTE病史显著相关.
结论：接受RC的患者术前VTE的发病率明显增加，术后VTE事件,住院时间,重新住院,医院费用增加。这些发现可能有助于BCa咨询手术风险，并有望提高我们减轻此类风险的能力。
方法：在2007年至2021年期间，Merative™Marketscan®研究数据库中确定了年龄≥18岁的BCa诊断并接受开放或微创（MIS）RC的患者。既往VTE病史与90天并发症发生率的相关性，术后VTE事件,再住院,和总住院费用(2021美元)通过多变量逻辑回归模型确定,校正了患者和围手术期的混杂因素.VTE严重程度的敏感性分析(即，还检查了肺栓塞[PE]和/或外周深静脉血栓形成[DVT]）。
结果：在8759个RC程序中，743（8.48％）有任何VTE的阳性病史，包括245（32.97％）PE，339（45.63%）DVT和159（21.40%）浅表VTE。总的来说,RC前的VTE病史与几乎所有更差的术后结局密切相关,包括任何和特定于器械的术后90天并发症的高风险(比值比[OR]:1.21,95%CI,1.02~1.44).新的VTE事件的后续发生率（OR：7.02，95％CI：5.93-8.31），再住院（OR：1.25，95%CI：1.06-1.48），除家庭/自理出院状态外（OR：1.53，95%CI：1.28-1.82），与RC手术相关的较高医疗保健费用(OR:1.43,95%CI:1.22-1.68)与VTE病史显著相关.
结论：接受RC的患者术前VTE的发病率明显增加，术后VTE事件,住院时间,重新住院,医院费用增加。这些发现可能有助于BCa咨询手术风险，并有望提高我们减轻此类风险的能力。
