Surgical operation duration as a predictor of venous thromboembolism risk after radical cystectomy

We assess the impact of operation duration (OD) on the occurrence of symptomatic venous thromboembolism (VTE) in patients undergoing radical cystectomy (RC). We also seek to determine a threshold OD and quantify additional risk beyond this benchmark.

The National Surgical Quality Improvement Program database was utilized to identify RC patients from 2007 to 2022. Patient demographics, preoperative lab results, surgical features, and medical history were compared between VTE patients and those without it. Multivariable logistic regression analyses were performed, taking into account major confounders such as age, gender, body mass index (BMI), functional stage, tobacco use, bleeding disease history, transfusions within 72 hours, and surgical type.

Of 24,503 RC patients identified, the median OD was 5.43 hours. VTE incidence within 30 days post-operation was 3.6% (n = 880). OD exceeding 6 hours emerged as an independent predictor of VTE (OR 1.16; 95% CI 1.10-1.21), with each additional hour beyond 6 hours escalating the risk by 16%. Higher BMI, advancing age, transfusions within 72 hours, immunosuppressive treatment, and continent diversion during RC were associated with increased VTE odds.

Extended OD during RC heightens VTE risk, with each hour beyond 6 hours posing a 16% increased risk. Establishing a definitive OD threshold and addressing factors affecting OD may mitigate VTE complications. Further research is warranted to explore interventions optimizing surgical efficiency and reducing VTE risk in RC patients.