Venous thromboembolism after radical prostatectomy: The effect of surgical caseload

Jan Schmitges, Quoc Dien Trinh, Maxine Sun, Firas Abdollah, Marco Bianchi, Lars Budäus, Georg Salomon, Thorsten Schlomm, Paul Perrotte, Shahrokh F. Shariat, Francesco Montorsi, Mani Menon, Markus Graefen, Pierre I. Karakiewicz

Research output: Contribution to journalArticlepeer-review


Objective To examine the effect of annual surgical caseload (ASC) on the likelihood of venous thromboembolism (VTE) after radical prostatectomy (RP). Patients and Methods Between 1999 and 2008, 36 699 RPs were performed in the state of Florida. Logistic regression models predicting the likelihood of VTE were fitted. Covariates included year of surgery, age, race, baseline Charlson Comorbidity Index (CCI), lymph node dissection, ASC and surgical approach. Results The overall VTE rate was 0.3%. It was higher in patients operated within the low (0.4%) and intermediate (0.3%) ASC tertile than in those operated within the high-ASC tertile (0.1%, P <0.001). Mortality rate was 6.0% in patients with VTE vs 0.1% in others (P <0.001). Median length of stay and median total hospital charges were 9 vs 3 days (P <0.001) and $51 571 vs $24 943 (P <0.001) in patients with VTE vs others, respectively. In multivariable analyses predicting VTE, patients operated on by low-ASC surgeons were at higher risk of VTE than those operated on by high-ASC surgeons (odds ratio [OR]= 3.78, P <0.001). Additionally, black patients were more likely to experience a VTE (OR = 1.80, P= 0.023). Patients with CCI ≥ 1 were also more likely to experience a VTE than others (OR = 1.65, P= 0.016). Conversely, patients who had undergone minimally invasive radical prostatectomy were not more likely to experience a VTE than those who had undergone open RP (OR = 1.97, P= 0.086). Conclusions RP by high-ASC surgeons exerts a protective effect on the likelihood of VTE. Additionally, VTE is associated with higher mortality, prolonged length of stay and increased hospital charges.

Original languageEnglish
Pages (from-to)828-833
Number of pages6
JournalBJU International
Issue number6
Publication statusPublished - Sep 2012


  • perioperative complications
  • prostatectomy
  • prostatic neoplasms
  • venous thromboembolism

ASJC Scopus subject areas

  • Urology

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