TY - JOUR
T1 - Trends in Extended-Duration Venous Thromboembolism Prophylaxis Following Radical Cystectomy
AU - Lyon, Timothy D.
AU - Shah, Nilay D.
AU - Tollefson, Matthew K.
AU - Shah, Paras H.
AU - Sangaralingham, Lindsey R.
AU - Asante, Dennis
AU - Thompson, R. Houston
AU - Karnes, R. Jeffrey
AU - Frank, Igor
AU - Boorjian, Stephen A.
N1 - Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2020/2
Y1 - 2020/2
N2 - Objective: To evaluate temporal trends in prescriptions for extended-duration pharmacologic prophylaxis (EDPP) intended to prevent venous thromboembolism following radical cystectomy (RC). Materials and Methods: We used OptumLabs Data Warehouse, a national administrative claims database, to identify patients undergoing RC for bladder cancer from 2012 to 2017. Rates of outpatient prescriptions for EDPP following RC were assessed, and rate over time was evaluated using the Cochran-Armitage test for trend. Multivariable logistic regression was used to examine associations between clinical and practice-level characteristics with EDPP prescriptions. Results: A total of 2054 patients were identified, including 386 (19%) who received an EDPP prescription. The rate of EDPP prescriptions increased significantly over the study period, from 9% of cases in 2012 to 26% of cases in 2017 (P <.001). On multivariable logistic regression, age <65 (OR 1.79, 95% CI 1.39-2.33; P <.001), receipt of neoadjuvant chemotherapy (OR 1.33, 95% CI 1.04-1.71; P =. 02), more recent procedure year (OR 4.11, 95% CI 2.35-7.18; P <.001), treatment in a public as compared to a for-profit hospital (OR 3.38, 95% CI 1.31-8.74; P =. 01), and treatment at a hospital with residency training (OR 4.45, 95% CI 1.26-15.7; P =. 02) or a surgical robot (OR 3.44, 95% CI 1.31-9.08; P =. 01) were significantly associated with increased odds of receiving EDPP. Conclusion: EDPP following RC has increased over time, but is still provided for only a minority of patients. These data may be useful for guiding quality improvement efforts given recent literature supporting the use of EDPP.
AB - Objective: To evaluate temporal trends in prescriptions for extended-duration pharmacologic prophylaxis (EDPP) intended to prevent venous thromboembolism following radical cystectomy (RC). Materials and Methods: We used OptumLabs Data Warehouse, a national administrative claims database, to identify patients undergoing RC for bladder cancer from 2012 to 2017. Rates of outpatient prescriptions for EDPP following RC were assessed, and rate over time was evaluated using the Cochran-Armitage test for trend. Multivariable logistic regression was used to examine associations between clinical and practice-level characteristics with EDPP prescriptions. Results: A total of 2054 patients were identified, including 386 (19%) who received an EDPP prescription. The rate of EDPP prescriptions increased significantly over the study period, from 9% of cases in 2012 to 26% of cases in 2017 (P <.001). On multivariable logistic regression, age <65 (OR 1.79, 95% CI 1.39-2.33; P <.001), receipt of neoadjuvant chemotherapy (OR 1.33, 95% CI 1.04-1.71; P =. 02), more recent procedure year (OR 4.11, 95% CI 2.35-7.18; P <.001), treatment in a public as compared to a for-profit hospital (OR 3.38, 95% CI 1.31-8.74; P =. 01), and treatment at a hospital with residency training (OR 4.45, 95% CI 1.26-15.7; P =. 02) or a surgical robot (OR 3.44, 95% CI 1.31-9.08; P =. 01) were significantly associated with increased odds of receiving EDPP. Conclusion: EDPP following RC has increased over time, but is still provided for only a minority of patients. These data may be useful for guiding quality improvement efforts given recent literature supporting the use of EDPP.
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U2 - 10.1016/j.urology.2019.09.047
DO - 10.1016/j.urology.2019.09.047
M3 - Article
C2 - 31715273
AN - SCOPUS:85076611043
SN - 0090-4295
VL - 136
SP - 105
EP - 111
JO - Urology
JF - Urology
ER -