Incidence and risk factors of in-hospital venous thromboembolism in non-oncological urological inpatients: A single center experience

doi:10.1016/j.ajur.2021.11.007

Asian Journal of Urology, 2023, 10 (4): 546-554 doi: 10.1016/j.ajur.2021.11.007

Original Articles

Incidence and risk factors of in-hospital venous thromboembolism in non-oncological urological inpatients: A single center experience

Zhao Wang^a,Kaixuan Li^a,Quan Zhu^a,Haozhen Li^a,Ziqiang Wu^a,Xuesong Liu^a,Zhengyan Tang^a,b,*(

)

^aDepartment of Urology, Xiangya Hospital, Central South University, Changsha, China
^bProvincial Laboratory for Diagnosis and Treatment of Genitourinary System Disease, Changsha, China

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Abstract

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.

Key words： Venous thromboembolism Non-oncological surgery Urological inpatient Incidence Risk factor

Received: 16 March 2021 Available online: 20 October 2023

Corresponding Authors: *Department of Urology, Xiangya Hospital, Central South University, China. E-mail address: xytzyan@163.com (Z. Tang).

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Cite this article:

Zhao Wang,Kaixuan Li,Quan Zhu, et al. Incidence and risk factors of in-hospital venous thromboembolism in non-oncological urological inpatients: A single center experience[J]. Asian Journal of Urology, 2023, 10(4): 546-554.

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http://www.ajurology.com/EN/10.1016/j.ajur.2021.11.007 OR http://www.ajurology.com/EN/Y2023/V10/I4/546

Baseline characteristics associated with VTE.

Characteristic	Patients, n (%)	VTE		Univariate analysis	Unadjusted OR (95% CI)
Characteristic	Patients, n (%)	n (%)	Incidence, %	Univariate analysis	Unadjusted OR (95% CI)
Emergency surgery				p=0.240^a
No	1413 (97.2)	32 (94.1)	2.3		1
Yes	40 (2.8)	2 (5.9)	5.0		2.27 (0.53-9.82)
Hypertension				χ²=1.407; p=0.235
No	1069 (73.6)	22 (64.7)	2.1		1
Yes	384 (26.4)	12 (35.3)	3.1		1.54 (0.75-3.13)
Heart failure				p=1.000^a
No	1452 (99.9)	34 (100.0)	2.3
Yes	1 (0.1)	0 (0.0)	0
CHD				p=1.000^a
No	1380 (95.0)	33 (97.1)	2.4		1
Yes	73 (5.0)	1 (2.9)	1.4		0.57 (0.08-4.20)
Other cardiovascular diseases				p=0.222^a
No	1415 (97.4)	32 (94.1)	2.3		1
Yes	38 (2.6)	2 (5.9)	5.3		2.40 (0.55-10.41)
DM				p=0.207^a
No	1328 (91.4)	29 (85.3)	2.2		1
Yes	125 (8.6)	5 (14.7)	4.0		1.87 (0.71-4.91)
Previous VTE				p=0.000^a
No	1425 (98.1)	27 (79.4)	1.9		1
Yes	28 (1.9)	7 (20.6)	25.0		17.26 (6.77-44.02)^b
Family history of thrombosis				p=1.000^a
No	1383 (95.2)	33 (97.1)	2.4		1
Yes	70 (4.8)	1 (2.9)	1.4		0.59 (0.08-4.40)
History of varicose veins in the lower extremities				p=0.064^a
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=0.017^a
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=0.000^a
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=0.248^a
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=0.500^a
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=0.205^a
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=0.000^a	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=0.000^a	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=0.000^a
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=0.069^a
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=0.000^a
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

Characteristics of medical history, D-dimer, Caprini score, and symptoms associated with VTE.

Surgery-related characteristics associated with VTE.

Clinical factors associated with VTE based on multivariate logistic regression analysis.

Clinical factors associated with VTE based on multivariate stepwise logistic regression analysis.

Incidence of VTE in major non-oncological urological surgeries.

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