Hospital Episode Statistics data analysis of postoperative venous thromboembolus in patients undergoing urological surgery: a review of 126,891 cases

Introduction

Current guidelines on venous thromboembolism (VTE) prevention do not reflect the potential varying risk for patients undergoing different urological procedures. Our study aimed to establish the procedure specific rate of postoperative VTE in patients undergoing urological surgery.

Methods

Hospital Episode Statistics were obtained for all patients undergoing common urological procedures between April 2009 and April 2010. This cohort was followed up to identify all patients reattending with either deep vein thrombosis (DVT) or pulmonary embolism (PE) within 12 months.

Results

A total of 126,891 individuals underwent urological surgery during the study period. This included 89,628 men (70.6%) and 37,236 women (29.3%) with a mean age of 65.2 years. At the 12-month follow-up, 839 patients (0.66%) were readmitted with VTE. Of these, 373 (0.29%) were admitted with DVT and 466 (0.37%) with PE. The procedure-specific rate of VTE varied significantly between 2.86% following cystectomy and 0.23% following urethral dilatation. Procedures performed in the lithotomy position carried a significantly lower risk of VTE than those performed in the supine position (0.60% vs 1.28%, p<0.0001). Furthermore, of all procedures performed in the lithotomy position, those performed on benign conditions carried a significantly lower risk than those performed on malignant disease (0.52% vs 0.79%, p<0.0001).

Conclusions

Procedure specific rates of postoperative VTE vary widely among patients undergoing urological procedures. These findings suggest the potential benefit of prolonging the use of thromboprophylaxis in high-risk patients but also exploring the apparent lack of need for routine thromboprophylaxis in patients undergoing low-risk procedures.

Clinical implications of machine-probe combinations on obstetric ultrasound measurements used in pregnancy dating

OBJECTIVE

To investigate the effect of use of different machine-probe combinations on measurement variability and to assess how this variability impacts on accuracy of pregnancy dating.

METHODS

Sixteen different ultrasound machine-probe combinations were used for lateral measurement of targets spaced 10 and 40 mm apart and axial measurement of targets spaced 10 and 50 mm apart in an ultrasound phantom, and differences between the measured and true values were determined. The mean of the 40-mm lateral measurements was used to estimate gestational age using standard obstetric dating tables for crown-rump length (CRL) and femur length (FL) and the mean of the 50-mm axial measurements was used to estimate gestational age using the obstetric dating tables for biparietal diameter (BPD).

RESULTS

As absolute measurements became larger, differences observed using different machine-probe combinations exceeded those due to intraobserver variability. Maximum dating differences for first-trimester CRL of 2 days (based on a measured CRL range of 39-42 mm), second-trimester BPD of 4 days (based on a measured BPD range of 49-52 mm) and FL of 9 days (based on a measured FL range of 39-42 mm) were observed when measurements were transposed to the equivalent gestational age using standard charts.

CONCLUSION

Differences between measured and true values of biometric measurements reflect both machine-probe and intraobserver variability. Incremental first-trimester CRL growth with time is rapid, but second-trimester FL growth is much less so, leaving this lateral measurement more prone to both observer and machine-probe errors. The only axial growth measurement commonly performed is BPD where the measurement differences were intermediate between those of CRL and FL. The differences that can be ascribed to different equipment combinations are in many cases greater than those expected in clinical practice and are of potential importance in determining how fetal biometry is used for dating pregnancies.

Intraoperative radiotherapy and colorectal cancer

Intraoperative radiotherapy (IORT) is a highly specialized component of multidisciplinary management of advanced and recurrent colorectal cancer. The aim of this review was to assess its role and effectiveness in the management of colorectal cancer. A literature search was performed using Medline, Embase, Ovid and Cochrane to identify English language studies which have used IORT in the multidisciplinary management of primary and recurrent colon and rectal cancers. Improved survival and local control in patients with involved surgical margins treated with IORT have been shown in many studies, but these results have been mainly from retrospective studies. There is associated morbidity from IORT. IORT does have a role in the management of colorectal cancer. Further research needs to be performed to optimize the application of this therapy.

Bone scintigraphy (BS) may no longer be relevant in the era of integrated PET/CT for women undergoing evaluation for suspected metastatic breast cancer (MBC)

Abstract #5007

Background: &#x2028; The accurate detection of osseous metastases frequently has significant prognostic and therapeutic implications at metastatic breast cancer (MBC) diagnosis. However, the ideal paradigm for accurate detection of osseous metastases has not yet been determined. In this retrospective, single-institution study, we compare the diagnostic performance of integrated positron emission tomography/computed tomography (PET/CT) versus bone scintigraphy (BS) for women undergoing extent-of-disease (EOD) evaluation for suspected MBC.&#x2028; Methods:&#x2028; Women undergoing EOD evaluation for suspected MBC with integrated PET/CT and bone scintigraphy (BS) between January 1, 2005 and Dec 31, 2007 were identified through institutional databases. Patients with PET/CT and BS imaging completed within 30-days of each other were included. Women with a prior history of MBC or an active second malignancy were excluded. Electronic medical record (EMR) reports were reviewed and classified as positive, negative or equivocal for detecting osseous metastases. All EMR reports deemed potentially equivocal were reviewed by 2 investigators and consensus reached regarding the final classification. Bone biopsy data, where available, was also recorded.&#x2028; Results:&#x2028; The median age of the 62 eligible women was 54y (33-90y). Overall, PET/CT and BS demonstrated a high degree of concordance. Of the 41 concordant studies, 13 (21%) and 28 (45%) were reported as positive and negative for osseous metastases, respectively. No studies were classified as equivocal by both modalities. Ten positive PET/CT studies were negative by BS, but no PET/CT-negative studies were positive by BS. Of the 10 patients with PET/CT-positive, BS-negative studies, 4 had subsequent bone biopsies, all of which confirmed osseous metastases.&#x2028; &#x2028; Conclusions:&#x2028; This study supports the diagnostic performance of integrated PET/CT in detecting osseous metastases when EOD evaluation for suspected MBC is considered. Whether PET/CT may supplant BS entirely in this setting has not yet been determined.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5007.