Introduction: Radical cystectomy (RC) is a surgery associated with significant morbidity including perioperative blood transfusion, which can be as high as 40% within 30 days after surgery. The risk of venous thromboembolism (VTE) in the perioperative setting after RC can be as high as 5%. Few studies have assessed the quantitative effect of perioperative blood transfusion with the development of VTE after RC. Herein we aim to develop a model that would provide information on the relationship between perioperative blood transfusion and the development of VTE after RC.
Methods: This is a retrospective review of all patient who underwent RC at our institution between January 2007 and December 2020. Patient with a history of prior VTE, those taking anticoagulation prior to surgery, and patients with metastatic disease were excluded. A venous thromboembolism was defined as either a deep venous thrombosis or pulmonary embolism. Patients who developed a VTE within 30 days after surgery were compared to those who did not. Logistic regression was performed to assess the association between covariates and the probability of VTE within 30 days after surgery. A multivariable model was developed as a tool to predict VTE occurrence after surgery.
Results: There were 656 total patients identified, 24 (3.7%) of whom developed a VTE within 30 days after surgery. The cohorts were similar with respect to age, sex, race, comorbidity index, clinical stay, BMI. Patient who developed a VTE experienced a longer mean operative time (399.4 vs 351.1 minutes, p=0.040) and received a greater mean number of transfused units of blood during their stay (2.42 vs 1.26, p=0.040). The variables included in the model were selected based on the univariate analysis and on an a priori basis and included blood transfusion, age, BMI, comorbidity index, smoking status, and operative time. On multivariable logistic regression, each unit of transfused blood given during a patient’s hospital stay was significantly associated with development of VTE (OR 1.16, 95% CI 1.01-1.34), as was operative time (OR 1.38, 95% CI 1.06-1.78). The area under the curve for the model developed to predict development of VTE was 0.750.
Conclusions: The incidence of perioperative blood transfusion is significant at the time of radical cystectomy. This study demonstrates that blood transfusion was associated with a 16% increased risk for developing the VTE per unit transfused. The results of this study should be validated using, multiinstitutional data in order to permit generalizability and application of the multivariable model.
Source of Funding: This study was supported by Grant Number P30 CA015083 from the National Cancer Institute (NCI) from the Robert D. and Patricia E. Kern Center for Health Care Delivery Science (M.D.T.), the Christian Haub Family Career Development Award for Cancer Research Honoring Dr Richard Emslander (M.D.T.), and the Eric and Gail Blodgett Foundation (M.D.T.).
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