MP52-12: Risk Factors Associated with Venous Thromboembolism after Artificial Urinary Sphincter Surgery? An Assessment of 4,870 Patients

Kevin Hebert*, Niraj Paudel, Rupam Das, Rano Matta, Joshua Calvert, Benjamin McCormick, Joshua Horns, Salt Lake City, UT, James Hotaling, Salt Lake City , UT, Jeremy Myers, Salt Lake City, UT

Introduction: VTE (venous thromboembolism) following AUS (artificial urinary sphincter) surgery has been considered low risk. However, well powered studies assessing this risk are absent. We sought to evaluate the incidence and associated risk factors for postoperative VTE using a large cohort of 4870 men undergoing AUS surgery.

Methods: We performed a retrospective study of men undergoing AUS surgery between 2008-2017 using IBM MarketScan, a large commercial claims database. Men were identified using AUS common procedural terminology codes (53447, 53445, 53448) and were assessed for post-operative VTE events (pulmonary embolism (PE) and deep vein thrombosis (DVT)) within 90 days of surgery. Preoperative risk factors based on the Caprini score risk system were assessed and included: spinal cord injury, varicose veins, hypercoagulable state, Factor V Leiden, prothrombin gene, lupus anticoagulant, anticardiolipin, previous DVT/PE. These risk factors and their association with post-operative VTE were analyzed using a Cox proportional hazards model from time of surgery to 90 days post-op.

Results: We identified 4870 men, median age 68 years (IQR 62-75), who underwent AUS surgery between 2008-2017. History of prostate cancer (81.6%), prostatectomy (21.8%), peripheral vascular disease (8.6%), cardiovascular disease (34.4%), and hypertension (68.2%) were common. Likewise, prior history of DVT or PE was present in 2.7% and 1.7% patients, respectively. Within 90 days of AUS surgery, the incidence of DVT and PE were 1.1% and 0.8%, respectively. First time post-operative DVT and PE events occurred in 0.5% and 0.4% patients, respectively. Of the patients experiencing a DVT or PE for the first time, 56.8% were diagnosed in an emergency department setting. History of varicose veins (HR 2.8, 95% CI [1.1-6.8], p=.028), prior DVT (HR 13.7, 95% CI [7.4-25.2], p<0.001) or PE (HR 7.7, 95% CI [4.0-14.6], p<0.001) were associated with increased risk of postoperative DVT or PE while, prior prostatectomy (HR 0.32, p=0.003) was associated with decreased risk of postop events. No additional risk factors were independently associated with post-operative VTE risk.

Conclusions: The incidence of post-operative VTE events is higher in men undergoing AUS surgery compared to outpatient urologic surgeries of similar duration. Prior history of varicose veins, DVT, and PE are associated with increased risk post-operative VTE events, while prior prostatectomy is protective. This data should be used in preoperative setting for risk stratification and postoperatively for patient education.

Source of Funding: N/A