The need for a post-operative thromboembolic event registry? A five-year retrospective tertiary institution study of venothromboembolic events within 30 days of major urological surgery

Background: Recent evidence has suggested that the use of extended (<= 28 +/- seven days) post-operative low-molecularweight heparin (LMWH) therapy following major abdominal/pelvic surgery can significantly reduce the risk of deep vein thrombosis (DVT) and pulmonary embolism (PE). However, there is still significant discordance as to optimal LMWH duration among general and urological surgeons. There is marked variation over prescribing practices within urological surgery, and prospective studies have not reached a consensus. We aimed to determine if there was a significant prevalence of symptomatic thromboembolic events post-major urological surgery. Materials and methods: A five-year retrospective audit of major urological cases undertaken in our institution sought to examine the number of vascular complications encountered within 30 +/- seven days of surgery by patients on standard thromboprophylactic therapy. Results: A total of 439 major surgical cases were carried out, of which 79% were oncological. Ninety-three per cent of patients had at least one cardiovascular disease risk factor. There was one post-operative clinically evident DVT (0.22%) and no PEs in this cohort. Conclusion: Our results suggest that symptomatic thromboembolic events post-major urological surgery may be infrequent. However, there is the need for a comprehensive multi-centre prospective study to examine for thromboembolic events post-discharge. As such, we must recommend careful patient selection in determining who would benefit from extended thromboprophylaxis.