Safety of perioperative subcutaneous heparin for partial nephrectomy

The development of deep venous thrombosis (DVT) or pulmonary embolism (PE) following urologic surgery is a life threatening, but largely preventable complication. Patients undergoing partial nephrectomy are at increased risk for the development of DVT or PE as they often possess multiple risk factors including malignancy, advanced age, and prolonged surgical time. This risk can be significantly reduced by administration of perioperative subcutaneous heparin (SQH), however many surgeons feel this is contraindicated due to potential blood loss and related complications.

The medical records of 293 consecutive patients undergoing planned open, laparoscopic, or robotic assisted partial nephrectomy by a single surgeon over a 7 year period were reviewed. Approximately halfway through the period, the standard DVT prevention practice was changed from sequential compression stockings and early ambulation to include 5000 units of SQH administered 30-60 minutes prior to incision and continuing every 8 hours until discharge.

A total of 158 patients received perioperative SQH. There was no significant difference in surgical blood loss, transfusions, operative time, change in pre to postoperative hemoglobin or creatinine, conversion to radical nephrectomy, or duration of stay between the groups. There were no DVTs in either group. There was one PE in the group receiving SQH which was incidentally discovered.

Patients undergoing renal surgery for cancer are at increased risk for the development of DVT and PE. Prophylaxis against this serious complication with perioperative SQH is safe in patients undergoing partial nephrectomy despite common surgeon concerns regarding blood loss and related complications.