Abstract: Prevention of venous thromboembolism after colorectal surgery remains challenging. National guidelines endorse thromboembolism prophylaxis for 4 weeks after colorectal cancer resection. Expert consensus favors extended prophylaxis after IBD surgery. The actual frequency of prescription after resection remains unknown. OBJECTIVE: This study aimed to assess prescription of extended, postdischarge venous thromboembolism prophylaxis after resection in Michigan. DESIGN: This is a retrospective review of elective colorectal resections within a statewide collaborative receiving postdischarge, extended-duration prophylaxis. SETTING: This study was conducted between October 2015 and February 2018 at an academic center. PATIENTS: A total of 5722 patients (2171 with colorectal cancer, 266 with IBD, and 3285 with other). MAIN OUTCOME MEASURES: We compared the prescription of extended, postdischarge prophylaxis over time, between hospitals and by indication. RESULTS: Of 5722 patients, 373 (6.5%) received extended-duration prophylaxis after discharge. Use was similar between patients undergoing surgery for cancer (282/2171, 13.0%) or IBD (31/266, 11.7%, p = 0.54), but was significantly more common for both patients undergoing surgery for cancer or IBD in comparison with patients with other indications (60/3285, 1.8%, p 〈 0.001). Use increased significantly among patients with cancer (6.8%–16.8%, p 〈 0.001) and patients with IBD (0%–15.1%, p 〈 0.05) over the study period. For patients with other diagnoses, use was rare and did not vary significantly (1.5%–2.3%, p = 0.49). Academic centers and large hospitals ( 〉 300 beds) were significantly more likely to prescribe extended-duration prophylaxis for all conditions (both p 〈 0.001), with the majority of prophylaxis concentrated at only a few hospitals. LIMITATIONS: This study was limited by the lack of assessment of actual adherence, small number of observed venous thromboembolism events, small sample of patients with IBD, and restriction to the state of Michigan. CONCLUSIONS: The use of extended-duration venous thromboembolism prophylaxis after discharge is increasing, but remains uncommon in most hospitals. Efforts to improve adherence may require quality implementation initiatives or targeted payment incentives. See Video Abstract at http://links.lww.com/DCR/B193. ANÁLISIS POBLACIONAL DE LA ADHERENCIA A LA PROFILAXIS ANTI-TROMBÓTICA EXTENDIDA (TEV) EN PACIENTES DE ALTA LUEGO DE UNA RESECCIÓN COLORECTAL. ANTECEDENTES: La prevención del tromboembolismo venoso después de cirugía colorrectal sigue siendo un desafío. Las guías nacionales han aprobado la profilaxia del tromboembolismo durante cuatro semanas luego de una resección de cáncer colorrectal. El consenso de expertos favorece la profilaxia extendida solamente después de la cirugía por enfermedad inflamatoria intestinal. La frecuencia real de prescripción después de la resección colorrectal sigue siendo desconocida. OBJETIVO: Evaluar la prescripción de profilaxia prolongada de tromboembolismo venoso después del alta luego de una resección colorrectal en Michigan. DISEÑO: Revisión retrospectiva de las resecciones colorrectales electivas seguidas de una profilaxia de larga duración con el apoyo de todo el estado (MI). AJUSTE: Este estudio se realizó entre octubre de 2015 y febrero de 2018 en un solo centro académico. PACIENTES: Un universo de 5722 pacientes operados (2171 por cáncer colorrectal, 266 por enfermedad inflamatoria intestinal, 3285 por otros diagnósticos). PRINCIPALES RESULTADOS: Se comparó la prescripción de profilaxia prolongada después del alta según la duración, los hospitales y la indicación. RESULTADOS: De 5722 pacientes, 373 (6.5%) recibieron profilaxia de duración prolongada después del alta. El uso fue similar entre pacientes sometidos a cirugía por cáncer (282/2171, 13.0%) o enfermedad inflamatoria intestinal (31/266, 11.7%, p = 0.54), pero fue significativamente más común para ambos en comparación con pacientes con otras indicaciones (60/3285, 1.8%, p 〈 0.001). El uso aumentó significativamente entre pacientes con cáncer (6.8% a 16.8% ( p 〈 0.001)) y en pacientes con enfermedad inflamatoria intestinal (0% a 15.1%, p 〈 0.05) durante el período de estudio. Para pacientes con otros diagnósticos, su utilización fue rara y no varió significativamente (1.5% a 2.3%, p = 0.49). Los centros académicos y los grandes hospitales ( 〉 300 camas) tenían mayor probabilidad de prescribir la profilaxia de duración extendida en todas las afecciones (ambas p 〈 0.001), pero la mayoría de las profilaxis se concentraron el algunos pocos grandes hospitales. LIMITACIONES: Este estudio estuvo limitado por la falta de evaluación de actuales adherentes, por el pequeño número de eventos tromboembólicos venosos observados, por la pequeña muestra de pacientes con enfermedad inflamatoria intestinal y debido a ciertas restricciones en el estado de Michigan. CONCLUSIONES: El uso de profilaxia para el tromboembolismo venoso de duración prolongada después del alta está en aumento, pero su uso sigue siendo poco frecuente en la mayoría de los hospitales. Los esfuerzos para mejorar la adherencia al tratamiento pueden requerir iniciativas de mejoría en la calidad o incentivos específicos de reembolso. Consulte Video Resumen en http://links.lww.com/DCR/B193. (Traducción—Dr. Xavier Delgadillo )

Abstract: To identify the periprostatic structures associated with early return of urinary continence after radical prostatectomy (RP). Methods We compared total continence results between four different techniques of robot‐assisted radical prostatectomy (RARP). Specifically, we studied 1‐week and 1‐month zero‐pad continence rates of anterior ( n  = 60), posterior ( n  = 59), a novel hybrid posterior‐anterior ( n  = 12), and transvesical ( n  = 12) approaches of RARP. Each technique preserved a unique set of periprostatic anatomic structures, thereby, allowing evaluation of the individual impact of preservation of nerves, bladder neck, and space of Retzius with associated anterior support structures on early continence. Urethral length was preserved in all approaches. The space of Retzius was preserved in posterior and transvesical approaches, while the bladder neck was preserved in posterior and hybrid approaches. Nerve sparing was done per preoperative oncological risk. For all patients, 24‐h pad usage rates and 24‐h pad weights were noted at 1 week and 1 month after catheter removal. Multivariable logistic regression analysis was performed to identify predictors of early continence. Data were obtained from prospective studies conducted between 2015 and 2021. Results At 1 week, 15%, 42%, 45%, and 8% of patients undergoing anterior, posterior, hybrid, and transvesical RARP approaches, respectively, were totally continent ( p  = 0.003). These rates at 1 month were 35%, 66%, 64%, and 25% ( p  = 0.002), respectively. The transvesical approach, which preserved the space of Retzius but not the bladder neck, was associated with the poorest continence rates, while the posterior and hybrid approaches in which the bladder neck was preserved with or without space of Retzius preservation were associated with quickest urinary continence recovery. Bladder neck preservation was the only significant predictor of 1‐week and 1‐month total continence recovery in adjusted analysis, Odds ratios 9.06 ( p  = 0.001) and 5.18 ( p  = 0.004), respectively. Conclusions The beneficial effect of the Retzius‐sparing approach on early continence recovery maybe associated with bladder neck preservation rather than space of Retzius preservation.