Does heparin prophylaxis reduce the risk of venous thromboembolism in patients undergoing robot-assisted prostatectomy?

Background And Purpose: Venous thromboembolism (VTE) is a major complication of urologic surgery. Data are limited regarding the benefits of heparin prophylaxis for patients undergoing minimally invasive urologic surgery. The American Urological Association recommends sequential compression devices (SCDs) for urologic laparoscopic and robot-assisted procedures but provides no clear recommendations for the use of pharmacologic prophylaxis. We compare the rates of postoperative VTE in two groups of patients undergoing robot-assisted prostatectomy (RP) by two surgeons-one who consistently used heparin with SCDs (group 1) and the other who used SCDs alone (group 2) for prophylaxis.

Patients And Methods: An Institutional Review Board approved, prospectively managed database was analyzed. Group 1 received SCDs just before induction and 5000 units of heparin subcutaneously just after induction. SCDs were continued postoperatively, and heparin was administered twice a day until discharge. VTE rate, patient age, body mass index (BMI), operative time, lymphocele rate, length of stay (LOS), estimated blood loss (EBL), Gleason score, and pathologic stage were compared. Categorical variables were analyzed with the chi square test of proportions and continuous variables with t test using SPSS v 14 software.

Results: There were 1486 consecutive patients who underwent RP between August 2007 and December 30, 2011. Of these, 922 patients received heparin/SCDs and 564 received SCDs alone. Age, BMI, EBL, medial LOS, Gleason score, and pathologic stage were the same in the two groups. There was a higher rate of positive nodes in group 2 (1.3% vs 3.5%). There was one lymphocele in each group. Although operative times were longer in group 2 (229 vs 170 min, P<0.001), the incidence of VTE was not statistically different (1.0% vs 0.7%, P=0.78). BMI, operative time, EBL, and the performance of lymph node dissection were not associated with VTE.

Conclusions: The risk of VTE in patients undergoing RP is low and not significantly reduced with the administration of prophylactic heparin/SCDs compared with SCDs alone.