aDepartment of Urology, Xiangya Hospital, Central South University, Changsha, China bProvincial Laboratory for Diagnosis and Treatment of Genitourinary System Disease, Changsha, China
Objective: To determine incidence and risk factors for venous thromboembolism (VTE) development of in-hospital VTE in urological inpatients who underwent non-oncological surgery in a tertiary hospital in China.
Methods: Consecutive 1453 inpatients who were admitted to a non-oncological urological ward in the tertiary hospital from January 1, 2018 to December 31, 2018 were enrolled in the study, and the VTE events were diagnosed by ultrasound or computed tomographic pulmonary angiography. Patients’ occurrence of VTE and characteristics which may contribute to the development of VTE were collected and analyzed as incidence and risk factors.
Results: The incidence of VTE in non-oncological urological inpatients is 2.3%. In our cohort, patients who experienced previous VTE (adjusted odds ratios [aOR] 14.272, 95% CI 3.620-56.275), taking anticoagulants or antiplatelet agents before admission (aOR 10.181, 95% CI 2.453-42.256), D-dimer (max) ≥1 μg/mL (aOR 22.456, 95% CI 6.468-77.967), lower extremity swelling (aOR 10.264, 95% CI 2.242-46.994), chest symptoms (aOR 79.182, 95% CI 7.132-879.076), operation time of more than or equal to 180 min (aOR 10.690, 95% CI 1.356-84.300), and Caprini score (max) of more than or equal to 5 (aOR 34.241, 95% CI 1.831-640.235) were considered as risk factors for VTE.
Conclusion: In this study, we found that the incidence of VTE in non-oncological surgery was about 2.3%, which was higher than some previous studies. Risk factors could be used for early detection and diagnosis of VTE.
. [J]. Asian Journal of Urology, 2023, 10(4): 546-554.
Zhao Wang, Kaixuan Li, Quan Zhu, Haozhen Li, Ziqiang Wu, Xuesong Liu, Zhengyan Tang. Incidence and risk factors of in-hospital venous thromboembolism in non-oncological urological inpatients: A single center experience. Asian Journal of Urology, 2023, 10(4): 546-554.
History of varicose veins in the lower extremities
p=0.064a
No
1413 (97.2)
31 (91.2)
2.2
1
Yes
40 (2.8)
3 (8.8)
7.5
3.62 (1.06-12.36)b
History of surgery within 1 month
p=0.017a
No
1409 (97.0)
30 (88.2)
2.1
1
Yes
44 (3.0)
4 (11.8)
9.1
4.60 (1.55-13.67)b
Anticoagulants or antiplatelet agents before admission
p=0.000a
No
1431 (98.5)
27 (79.4)
1.9
1
Yes
22 (1.5)
7 (20.6)
31.8
24.27 (9.16-64.31)b
COPD
p=0.248a
No
1441 (99.2)
33 (97.1)
2.3
1
Yes
12 (0.8)
1 (2.9)
8.3
3.88 (0.49-30.92)
Cancer history
p=0.500a
No
1424 (98.0)
33 (97.1)
2.3
1
Yes
29 (2.0)
1 (2.9)
3.4
1.51 (0.20-11.40)
Cerebral stroke
p=0.205a
No
1417 (97.5)
32 (94.1)
2.3
1
Yes
36 (2.5)
2 (5.9)
5.6
2.55 (0.59-11.06)
D-dimer, max, μg/mL
p=0.000a
5.42 (3.31-8.87)b
<0.5
1048 (72.1)
4 (11.8)
0.4
1
0.5-1
160 (11.0)
4 (11.8)
2.5
6.69 (1.66-27.03)b
≥1
245 (16.9)
26 (76.5)
10.6
30.99 (10.71-89.68)b
Caprini score, max
p=0.000a
1.60 (1.34-1.91)b
≤2
94 (6.5)
1 (2.9)
1.1
1
3-4
747 (51.4)
7 (20.6)
0.9
0.88 (0.11-7.23)
≥5
612 (42.1)
26 (76.5)
4.2
4.13 (0.55-30.77)
Lower extremity swelling
p=0.000a
No
1438 (99.0)
28 (82.4)
1.9
1
Yes
15 (1.0)
6 (17.6)
40.0
33.57 (11.19-100.72)b
Lower extremity pain
p=0.069a
No
1450 (99.8)
33 (97.1)
2.3
1
Yes
3 (0.2)
1 (2.9)
33.3
21.47 (1.90-242.69)b
Chest symptoms
p=0.000a
No
1445 (99.4)
29 (85.3)
2.0
1
Yes
8 (0.6)
5 (14.7)
62.5
81.38 (18.57-356.72)b
Characteristic
Patients, n (%)
VTE
Univariate analysis, p-valuea
Unadjusted OR (95% CI)
n (%)
Incidence, %
Preoperative bleeding
0.003
No
1427 (98.2)
30 (88.2)
2.1
1
Yes
26 (1.8)
4 (11.8)
15.4
8.47 (2.75-26.08)b
Preoperative sepsis
0.015
No
1430 (98.4)
31 (91.2)
2.2
1
Yes
23 (1.6)
3 (8.8)
13.0
6.77 (1.91-23.98)b
ASA score
0.000
2.61 (1.34-5.10)b
1-2
791 (59.0)
7 (31.8)
0.9
1
3
510 (38.1)
13 (59.1)
2.5
2.93 (1.16-7.39)b
4
39 (2.9)
2 (9.1)
5.1
6.05 (1.22-30.16)b
Missing
113 (7.8)
12 (35.3)
10.6
13.31 (5.12-34.58)b
Operation time, min
0.000
2.49 (1.17-5.31)b
<60
553 (41.3)
4 (18.2)
0.7
1
60-179
735 (54.9)
16 (72.7)
2.2
3.05 (1.02-9.19)b
≥180
52 (3.9)
2 (9.1)
3.8
5.49 (0.98-30.72)
Missing
113 (7.8)
12 (35.3)
10.6
16.31 (5.16-51.57)b
Blood loss, mL
0.000
<100
1191 (82.0)
18 (52.9)
1.5
1
100-400
124 (8.5)
4 (11.8)
3.2
2.17 (0.72-6.62)
>400
25 (1.7)
0 (0.0)
0.0
-
Missing
113 (7.8)
12 (35.3)
10.6
7.74 (3.63-16.53)b
Re-admission surgery
0.379
No
1433 (98.6)
33 (97.1)
2.3
1
Yes
20 (1.4)
1 (2.9)
5.0
2.23 (0.29-17.18)
Complications
0.000
No
1395 (96.0)
25 (73.5)
1.8
1
Yes
58 (4.0)
9 (26.5)
15.5
10.07 (4.46-22.70)b
Variable
aOR
95% CI
p-Value
Age, year
41-65
4.397
0.408-47.357
0.222
≥66
5.332
0.415-68.519
0.199
Previous VTE
17.056a
3.902-74.558
0.000
History of varicose veins in the lower extremities
1.598
0.238-9.032
0.596
History of surgery within 1 month
1.436
0.260-7.947
0.678
Anticoagulants or antiplatelet agents before admission
8.137a
1.821-36.363
0.006
Preoperative bleeding
0.878
0.090-8.580
0.911
Preoperative sepsis
3.365
0.450-25.184
0.237
D-dimer, max, μg/mL
0.5-1
2.171
0.379-12.424
0.384
≥1
17.578a
4.627-66.775
0.000
Caprini score, max
3-4
13.131
0.587-293.783
0.104
≥5
18.579
0.939-367.682
0.055
Complications
2.504
0.698-8.978
0.159
Lower extremity swelling
9.188a
1.620-52.112
0.012
Lower extremity pain
14.975
0.058-3898.037
0.340
Chest symptoms
72.939a
6.146-865.597
0.001
ASA score
3
1.440
0.424-4.898
0.559
4
0.781
0.090-6.747
0.822
Operation time, min
60-179
3.250
0.891-11.850
0.074
≥180
17.466a
1.952-156.253
0.011
Blood loss, mL
100-400
0.785
0.170-3.631
0.756
>400
0.000
0.000
0.998
Variable
aOR
95% CI
p-Value
Previous VTE
14.272a
3.620-56.275
0.000
Anticoagulants or antiplatelet agents before admission
10.181a
2.453-42.256
0.001
D-dimer, max, μg/mL
0.5-1
2.545
0.452-14.318
0.289
≥1
22.456a
6.468-77.967
0.000
Caprini score, max
3-4
16.590
0.791-347.775
0.070
≥5
34.241a
1.831-640.235
0.018
Lower extremity swelling
10.264a
2.242-46.994
0.003
Chest symptoms
79.182a
7.132-879.076
0.000
Operation time, min
0.068
60-179
2.920
0.837-10.183
0.093
≥180
10.690a
1.356-84.300
0.025
Study
Country
Non-oncological urological surgeries
No. of patients
No. of VTE
Incidence, %
Turna et al., 2008 [12]
United States
RIRS and Ho:YAG lithotripsy
74
1
1.4
Sofer et al., 2010 [13]
Israel
PCNL
200
1
0.5
Singh et al., 2005 [14]
Canada
Kidney transplantation
68
5
7.4
Kusyk et al., 2005 [15]
United States
Kidney transplantation
326
2
0.6
Montgomery et al., 2005 [16]
United States
Kidney transplantation
122
1
0.8
Giron et al., 2008 [17]
United States
Kidney transplantation
85
1
1.2
Wadstr?m et al., 2011 [18]
Sweden
Kidney transplantation
413
4
1
O'Brien et al., 2012 [19]
United Kingdom
Kidney transplantation
383
1
0.3
Meriwether et al., 2013 [20]
United States
Prolapse surgery
52
1
1.9
Mueller et al., 2014 [21]
United States
Reconstructive pelvic surgery
33 710
95
0.3
Gordon et al., 2005 [22]
Israel
Reconstructive pelvic surgery
460
3
0.7
Mamoulakis et al., 2011 [23]
Greece
TURP
198
1
0.5
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