MP76-17: Peri-operative subcutaneous heparin is safe and reduces incidence of venous thromboembolism following placement of inflatable penile prostheses
Monday, May 6, 2024 1:00 PM to 3:00 PM · 2 hr. (US/Central)
304B
Abstract
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Full Abstract and Figures
Author Block
Jacob D Good, Thairo Pereira*, Nikos Crist, Helen L Bernie, Indianapolis, IN
Introduction
Patients undergoing inflatable penile prosthetic (IPP) surgery are generally at a higher risk for cardiovascular (CV) complications such as venous thromboembolism (VTE) following surgery, due to pre-existing comorbidities, such as age, obesity, smoking status, and vascular disease, which are all associated with erectile dysfunction (ED). The use of perioperative subcutaneous heparin (SqH) has shown to be effective in preventing VTE in urological surgery patients and IPP patients with concomitant drain placement. Not all prosthetic surgeons utilize surgical drains postoperatively. The American Urologic Association (AUA) perioperative VTE guidelines do not address VTE risk with IPP surgery. In this study we aim to assess the efficacy of perioperative SqH in preventing VTE in IPP patients without the use of a surgical drain, and to identify the incidence of VTE risk factors in this patient population.
Methods
This was a retrospective review from January 2019-September 2023 of patients who underwent IPP surgery at a single institution. Patient demographics, comorbidities, Caprini risk scores, VTE risk factors, intraoperative variables, hematoma incidence, and 90-day post-operative complications were reviewed. Chi-square analyses were performed comparing these variables in men who received SqH and those who did not.
Results
Of 419 IPP patients, 86% were classified as high risk for VTE utilizing the Caprini risk score (score =5). A total of 137 (33%) received perioperative SqH. The incidence of VTE was 0.7% (2/282) in the non-SqH group, while no VTE was recorded in the SqH group. There was no difference in hematoma formation between groups (SqH 5.1% vs. non-SqH 5.0% p=0.85). Caprini risk scores were similar (SqH 6.29 vs. non-SqH 6.39 p=.612). Average operative time was found to be significantly shorter in the non-SqH group (SqH 91.4 min vs. non-SqH 77.9, p=0.0002). There was no difference (p>.05) in comorbidities between groups evaluating BMI, diabetes, HTN, vascular disease, smoker status, malignancy history, COPD, MI, CVA/TIA, and CHF.
Conclusions
To our knowledge this is the largest study evaluating safety of SqH in IPP surgery. Perioperative SqH use without placement of a surgical drain was found to be safe and effective in preventing VTE in patients undergoing IPP surgery. There was no difference in hematoma formation or post-operative complications between the groups. Patients undergoing IPP surgery are at elevated risk for VTE and perioperative SqH should be considered in all patients undergoing IPP surgery.
Source Of Funding
N/A
Author Block
Jacob D Good, Thairo Pereira*, Nikos Crist, Helen L Bernie, Indianapolis, IN
Introduction
Patients undergoing inflatable penile prosthetic (IPP) surgery are generally at a higher risk for cardiovascular (CV) complications such as venous thromboembolism (VTE) following surgery, due to pre-existing comorbidities, such as age, obesity, smoking status, and vascular disease, which are all associated with erectile dysfunction (ED). The use of perioperative subcutaneous heparin (SqH) has shown to be effective in preventing VTE in urological surgery patients and IPP patients with concomitant drain placement. Not all prosthetic surgeons utilize surgical drains postoperatively. The American Urologic Association (AUA) perioperative VTE guidelines do not address VTE risk with IPP surgery. In this study we aim to assess the efficacy of perioperative SqH in preventing VTE in IPP patients without the use of a surgical drain, and to identify the incidence of VTE risk factors in this patient population.
Methods
This was a retrospective review from January 2019-September 2023 of patients who underwent IPP surgery at a single institution. Patient demographics, comorbidities, Caprini risk scores, VTE risk factors, intraoperative variables, hematoma incidence, and 90-day post-operative complications were reviewed. Chi-square analyses were performed comparing these variables in men who received SqH and those who did not.
Results
Of 419 IPP patients, 86% were classified as high risk for VTE utilizing the Caprini risk score (score =5). A total of 137 (33%) received perioperative SqH. The incidence of VTE was 0.7% (2/282) in the non-SqH group, while no VTE was recorded in the SqH group. There was no difference in hematoma formation between groups (SqH 5.1% vs. non-SqH 5.0% p=0.85). Caprini risk scores were similar (SqH 6.29 vs. non-SqH 6.39 p=.612). Average operative time was found to be significantly shorter in the non-SqH group (SqH 91.4 min vs. non-SqH 77.9, p=0.0002). There was no difference (p>.05) in comorbidities between groups evaluating BMI, diabetes, HTN, vascular disease, smoker status, malignancy history, COPD, MI, CVA/TIA, and CHF.
Conclusions
To our knowledge this is the largest study evaluating safety of SqH in IPP surgery. Perioperative SqH use without placement of a surgical drain was found to be safe and effective in preventing VTE in patients undergoing IPP surgery. There was no difference in hematoma formation or post-operative complications between the groups. Patients undergoing IPP surgery are at elevated risk for VTE and perioperative SqH should be considered in all patients undergoing IPP surgery.
Source Of Funding
N/A
