Abstract: PD52-09
Sources of Funding: None

Introduction

Renal mass detection has been on a steady incline over the past decade and subsequently, surgery for solid renal masses has also increased. 900,000 Americans are diagnosed with a VTE each year with the average cost being $56,000 to treat each incident. VTE is the number two cause of death behind the primary malignancy itself. As quality indicators and outcomes are more frequently being linked with reimbursement, venous thromboembolism (VTE) prevention has gained increased attention. Increasing the number of surgeries will also increase the incidence of VTE. The purpose of this study is to identify the incidence of VTE among renal cell carcinoma patients that have undergone definitive surgical therapy and to see if pharmacological prophylaxis following surgery is warranted.

Methods

Over a fourteen year period (2000-2014), all patients who had surgery for renal cell carcinoma were examined. A total of 900 patients had either open, laparoscopic or robotic surgery. This included partial, radical and cytoreductive nephrectomies. All VTE incidents that had occurred up until 2015 were documented. Patient demographics and comorbidities were analyzed for risk factors for VTE. All VTE incidents were documented in adjunct with known risk factors for each patient.

Results

Of the 900 patients that were evaluated, 10 were documented to have VTE, making the incidence 1.1%. 40% of these patients had a prior history of VTE. 20% of the patients with a VTE had metastatic disease at time of surgery. 90% of patients were obese with a mean BMI of 32.3. 50% of patients with postoperative VTE had tobacco use. 100% of patients with documented VTE had at least 1 risk factor for VTE while 80% of patients had greater than 2 risk factors.

Conclusions

VTE incident following renal cell carcinoma surgery was found to be 1.1%. All patients had at least one risk factor in addition to surgery. The rate of significant postoperative bleeding following surgical therapy for renal cell carcinoma requiring transfusion is noted to be 3-6%. Risks of postoperative bleeding and other complications outweigh the benefit pharmacological VTE may have with such a low incidence of VTE. Early ambulation and mechanical VTE prophylaxis are warranted following surgery. Although VTE was a rare event, those with multiple risk factors may warrant special consideration and more aggressive VTE prophylaxis following surgery.

Funding

None