Portomesenteric venous thrombosis following major colon and rectal surgery

incidence and risk factors

Kristin A. Robinson, Mark E. O’Donnell, David Pearson, J. Scott Kriegshauser, Melanie Odeleye, Kristen Kalkbrenner, Zachary Bodnar, Tonia M. Young-Fadok

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Portomesenteric venous thrombosis (PMVT) is an uncommon complication of abdominal surgery. The objective of this study was to assess PMVT risk factor profiles and patient outcomes after colorectal surgery. Methods: A single center retrospective review of patients undergoing colorectal surgery was performed (2007–2012). PMVT was defined as thrombus within the portal, splenic, or superior mesenteric vein on computed tomography (CT). Inferior mesenteric vein thrombosis was excluded. Independent samples t test was used to compare data variables between PMVT and non-PMVT patients. Univariate and multivariate logistic regression analyses were used to assess PMVT risk factors. Results: There were 1,224 patients included (mean age 62 years, male = 566). Elective bowel resection was performed for colon carcinoma (n = 302), rectal carcinoma (n = 112), ulcerative colitis (n = 125), Crohn’s disease (n = 78), polyps (n = 117), and diverticulitis (n = 215). Patients undergoing gynecological resections and emergent laparotomies were included (n = 275). Thirty-six patients (3 %) were diagnosed with PMVT by CT: 17/36 on initial presentation and 19/36 by expert radiologist review. Patients with PMVT were younger (53 vs. 62 years, p = 0.001) with higher BMI (30.5 vs. 26.7, p < 0.001) and thrombocytosis (464 vs. 306, p < 0.001) compared to patients without PMVT. Univariate logistic regression identified younger age (p < 0.001), obesity (p < 0.001), ulcerative colitis (p < 0.001), thrombocytosis, (p < 0.001) and proctocolectomy as significant predictors of PMVT. Stepwise multivariate logistic regression identified that obesity (p < 0.001), thrombocytosis, (p < 0.001) and restorative proctocolectomy (p = 0.001) were still significant predictors. No patients in the PMVT group suffered bowel infarction and no related mortalities occurred. Thirty-day readmission rates were higher in the PMVT group (53 % vs. 17 %, p < 0.01). Conclusion: BMI ≥ 30 kg/m<sup>2</sup>, thrombocytosis, and restorative proctocolectomy were significant predictors of PMVT. Initial diagnostic studies showed a PMVT rate of 1.4 %; however, after expert focused radiologic review, the actual rate was 3 %. Thus, the diagnosis of PMVT is difficult and readmission after colorectal surgery should prompt its consideration.

Original languageEnglish (US)
Pages (from-to)1071-1079
Number of pages9
JournalSurgical Endoscopy and Other Interventional Techniques
Volume29
Issue number5
DOIs
StatePublished - Apr 8 2015

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Venous Thrombosis
Colon
Incidence
Colorectal Surgery
Mesenteric Veins
Thrombosis
Tomography
Restorative Proctocolectomy
Carcinoma
Thrombocytosis
Diverticulitis
Polyps
Ulcerative Colitis
Crohn Disease
Laparotomy
Logistic Models
Regression Analysis

Keywords

  • Abdominal DVT
  • Colorectal surgery
  • Inflammatory bowel disease
  • Portomesenteric venous thrombosis
  • Risk factors

ASJC Scopus subject areas

  • Surgery

Cite this

Robinson, K. A., O’Donnell, M. E., Pearson, D., Scott Kriegshauser, J., Odeleye, M., Kalkbrenner, K., ... Young-Fadok, T. M. (2015). Portomesenteric venous thrombosis following major colon and rectal surgery: incidence and risk factors. Surgical Endoscopy and Other Interventional Techniques, 29(5), 1071-1079. https://doi.org/10.1007/s00464-014-3788-z

Portomesenteric venous thrombosis following major colon and rectal surgery : incidence and risk factors. / Robinson, Kristin A.; O’Donnell, Mark E.; Pearson, David; Scott Kriegshauser, J.; Odeleye, Melanie; Kalkbrenner, Kristen; Bodnar, Zachary; Young-Fadok, Tonia M.

In: Surgical Endoscopy and Other Interventional Techniques, Vol. 29, No. 5, 08.04.2015, p. 1071-1079.

Research output: Contribution to journalArticle

Robinson, KA, O’Donnell, ME, Pearson, D, Scott Kriegshauser, J, Odeleye, M, Kalkbrenner, K, Bodnar, Z & Young-Fadok, TM 2015, 'Portomesenteric venous thrombosis following major colon and rectal surgery: incidence and risk factors', Surgical Endoscopy and Other Interventional Techniques, vol. 29, no. 5, pp. 1071-1079. https://doi.org/10.1007/s00464-014-3788-z
Robinson, Kristin A. ; O’Donnell, Mark E. ; Pearson, David ; Scott Kriegshauser, J. ; Odeleye, Melanie ; Kalkbrenner, Kristen ; Bodnar, Zachary ; Young-Fadok, Tonia M. / Portomesenteric venous thrombosis following major colon and rectal surgery : incidence and risk factors. In: Surgical Endoscopy and Other Interventional Techniques. 2015 ; Vol. 29, No. 5. pp. 1071-1079.
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abstract = "Background: Portomesenteric venous thrombosis (PMVT) is an uncommon complication of abdominal surgery. The objective of this study was to assess PMVT risk factor profiles and patient outcomes after colorectal surgery. Methods: A single center retrospective review of patients undergoing colorectal surgery was performed (2007–2012). PMVT was defined as thrombus within the portal, splenic, or superior mesenteric vein on computed tomography (CT). Inferior mesenteric vein thrombosis was excluded. Independent samples t test was used to compare data variables between PMVT and non-PMVT patients. Univariate and multivariate logistic regression analyses were used to assess PMVT risk factors. Results: There were 1,224 patients included (mean age 62 years, male = 566). Elective bowel resection was performed for colon carcinoma (n = 302), rectal carcinoma (n = 112), ulcerative colitis (n = 125), Crohn’s disease (n = 78), polyps (n = 117), and diverticulitis (n = 215). Patients undergoing gynecological resections and emergent laparotomies were included (n = 275). Thirty-six patients (3 {\%}) were diagnosed with PMVT by CT: 17/36 on initial presentation and 19/36 by expert radiologist review. Patients with PMVT were younger (53 vs. 62 years, p = 0.001) with higher BMI (30.5 vs. 26.7, p < 0.001) and thrombocytosis (464 vs. 306, p < 0.001) compared to patients without PMVT. Univariate logistic regression identified younger age (p < 0.001), obesity (p < 0.001), ulcerative colitis (p < 0.001), thrombocytosis, (p < 0.001) and proctocolectomy as significant predictors of PMVT. Stepwise multivariate logistic regression identified that obesity (p < 0.001), thrombocytosis, (p < 0.001) and restorative proctocolectomy (p = 0.001) were still significant predictors. No patients in the PMVT group suffered bowel infarction and no related mortalities occurred. Thirty-day readmission rates were higher in the PMVT group (53 {\%} vs. 17 {\%}, p < 0.01). Conclusion: BMI ≥ 30 kg/m2, thrombocytosis, and restorative proctocolectomy were significant predictors of PMVT. Initial diagnostic studies showed a PMVT rate of 1.4 {\%}; however, after expert focused radiologic review, the actual rate was 3 {\%}. Thus, the diagnosis of PMVT is difficult and readmission after colorectal surgery should prompt its consideration.",
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AU - Pearson, David

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AU - Odeleye, Melanie

AU - Kalkbrenner, Kristen

AU - Bodnar, Zachary

AU - Young-Fadok, Tonia M.

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N2 - Background: Portomesenteric venous thrombosis (PMVT) is an uncommon complication of abdominal surgery. The objective of this study was to assess PMVT risk factor profiles and patient outcomes after colorectal surgery. Methods: A single center retrospective review of patients undergoing colorectal surgery was performed (2007–2012). PMVT was defined as thrombus within the portal, splenic, or superior mesenteric vein on computed tomography (CT). Inferior mesenteric vein thrombosis was excluded. Independent samples t test was used to compare data variables between PMVT and non-PMVT patients. Univariate and multivariate logistic regression analyses were used to assess PMVT risk factors. Results: There were 1,224 patients included (mean age 62 years, male = 566). Elective bowel resection was performed for colon carcinoma (n = 302), rectal carcinoma (n = 112), ulcerative colitis (n = 125), Crohn’s disease (n = 78), polyps (n = 117), and diverticulitis (n = 215). Patients undergoing gynecological resections and emergent laparotomies were included (n = 275). Thirty-six patients (3 %) were diagnosed with PMVT by CT: 17/36 on initial presentation and 19/36 by expert radiologist review. Patients with PMVT were younger (53 vs. 62 years, p = 0.001) with higher BMI (30.5 vs. 26.7, p < 0.001) and thrombocytosis (464 vs. 306, p < 0.001) compared to patients without PMVT. Univariate logistic regression identified younger age (p < 0.001), obesity (p < 0.001), ulcerative colitis (p < 0.001), thrombocytosis, (p < 0.001) and proctocolectomy as significant predictors of PMVT. Stepwise multivariate logistic regression identified that obesity (p < 0.001), thrombocytosis, (p < 0.001) and restorative proctocolectomy (p = 0.001) were still significant predictors. No patients in the PMVT group suffered bowel infarction and no related mortalities occurred. Thirty-day readmission rates were higher in the PMVT group (53 % vs. 17 %, p < 0.01). Conclusion: BMI ≥ 30 kg/m2, thrombocytosis, and restorative proctocolectomy were significant predictors of PMVT. Initial diagnostic studies showed a PMVT rate of 1.4 %; however, after expert focused radiologic review, the actual rate was 3 %. Thus, the diagnosis of PMVT is difficult and readmission after colorectal surgery should prompt its consideration.

AB - Background: Portomesenteric venous thrombosis (PMVT) is an uncommon complication of abdominal surgery. The objective of this study was to assess PMVT risk factor profiles and patient outcomes after colorectal surgery. Methods: A single center retrospective review of patients undergoing colorectal surgery was performed (2007–2012). PMVT was defined as thrombus within the portal, splenic, or superior mesenteric vein on computed tomography (CT). Inferior mesenteric vein thrombosis was excluded. Independent samples t test was used to compare data variables between PMVT and non-PMVT patients. Univariate and multivariate logistic regression analyses were used to assess PMVT risk factors. Results: There were 1,224 patients included (mean age 62 years, male = 566). Elective bowel resection was performed for colon carcinoma (n = 302), rectal carcinoma (n = 112), ulcerative colitis (n = 125), Crohn’s disease (n = 78), polyps (n = 117), and diverticulitis (n = 215). Patients undergoing gynecological resections and emergent laparotomies were included (n = 275). Thirty-six patients (3 %) were diagnosed with PMVT by CT: 17/36 on initial presentation and 19/36 by expert radiologist review. Patients with PMVT were younger (53 vs. 62 years, p = 0.001) with higher BMI (30.5 vs. 26.7, p < 0.001) and thrombocytosis (464 vs. 306, p < 0.001) compared to patients without PMVT. Univariate logistic regression identified younger age (p < 0.001), obesity (p < 0.001), ulcerative colitis (p < 0.001), thrombocytosis, (p < 0.001) and proctocolectomy as significant predictors of PMVT. Stepwise multivariate logistic regression identified that obesity (p < 0.001), thrombocytosis, (p < 0.001) and restorative proctocolectomy (p = 0.001) were still significant predictors. No patients in the PMVT group suffered bowel infarction and no related mortalities occurred. Thirty-day readmission rates were higher in the PMVT group (53 % vs. 17 %, p < 0.01). Conclusion: BMI ≥ 30 kg/m2, thrombocytosis, and restorative proctocolectomy were significant predictors of PMVT. Initial diagnostic studies showed a PMVT rate of 1.4 %; however, after expert focused radiologic review, the actual rate was 3 %. Thus, the diagnosis of PMVT is difficult and readmission after colorectal surgery should prompt its consideration.

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