TY - JOUR
T1 - Venous thromboembolism after surgery for inflammatory bowel disease
T2 - Are there modifiable risk factors? Data from ACS NSQIP
AU - Wallaert, Jessica B.
AU - De Martino, Randall R.
AU - Marsicovetere, Priscilla S.
AU - Goodney, Philip P.
AU - Finlayson, Sam R.G.
AU - Murray, John J.
AU - Holubar, Stefan D.
PY - 2012/11
Y1 - 2012/11
N2 - Although it is commonly reported that IBD patients are at increased risk for venous thromboembolic events, little real-world data exist regarding their postoperative incidence and related outcomes in everyday practice. OBJECTIVE: We aimed to identify the rate of venous thromboembolism and modifiable risk factors within a large cohort of surgical IBD patients. DESIGN: We performed a retrospective review of IBD patients who underwent colorectal procedures. PATIENTS: Patient data were obtained from the American College of Surgeons National Surgical Quality Improvement Program 2004 to 2010 Participant Use Data Files. MAIN OUTCOME MEASURES: The primary outcomes measured were short-term (30-day) postoperative venous thromboembolism (deep vein thrombosis and pulmonary embolism). Clinical variables were analyzed by univariate and multivariate analyses to identify modifiable risk factors for these events. RESULTS: A total of 10,431 operations were for Crohn's disease (52.1%) or ulcerative colitis (47.9%), and 242 (2.3%) venous thromboembolic events occurred (178 deep vein thromboses, 46 pulmonary embolisms, 18 both) for a combined rate of 1.4% in Crohn's disease and 3.3% in ulcerative colitis. Deep vein thrombosis and pulmonary embolism each occurred at a mean of 10.8 days postoperatively (range for each, 0-30 days). A multivariate model found that bleeding disorder, steroid use, anesthesia time, emergency surgery, hematocrit <37%, malnutrition, and functional status were potentially modifiable risk factors that remained associated (p < 0.05) with venous thromboembolism on regression analysis. Patients with thromboembolism had longer length of stay (18.8 vs 8.9 days), more complications (41% vs 18%), and a higher risk of death (4% vs 0.9%). LIMITATIONS: This study was limited by its retrospective design and its limited generalizability to nonparticipating hospitals. CONCLUSIONS: Inflammatory bowel disease patients are at increased risk for postoperative venous thromboembolism. Reducing preoperative anemia, steroid use, malnutrition, and anesthesia time may also reduce venous thromboembolism in this at-risk population. Risk-reducing, preventative strategies are needed in this at-risk population.
AB - Although it is commonly reported that IBD patients are at increased risk for venous thromboembolic events, little real-world data exist regarding their postoperative incidence and related outcomes in everyday practice. OBJECTIVE: We aimed to identify the rate of venous thromboembolism and modifiable risk factors within a large cohort of surgical IBD patients. DESIGN: We performed a retrospective review of IBD patients who underwent colorectal procedures. PATIENTS: Patient data were obtained from the American College of Surgeons National Surgical Quality Improvement Program 2004 to 2010 Participant Use Data Files. MAIN OUTCOME MEASURES: The primary outcomes measured were short-term (30-day) postoperative venous thromboembolism (deep vein thrombosis and pulmonary embolism). Clinical variables were analyzed by univariate and multivariate analyses to identify modifiable risk factors for these events. RESULTS: A total of 10,431 operations were for Crohn's disease (52.1%) or ulcerative colitis (47.9%), and 242 (2.3%) venous thromboembolic events occurred (178 deep vein thromboses, 46 pulmonary embolisms, 18 both) for a combined rate of 1.4% in Crohn's disease and 3.3% in ulcerative colitis. Deep vein thrombosis and pulmonary embolism each occurred at a mean of 10.8 days postoperatively (range for each, 0-30 days). A multivariate model found that bleeding disorder, steroid use, anesthesia time, emergency surgery, hematocrit <37%, malnutrition, and functional status were potentially modifiable risk factors that remained associated (p < 0.05) with venous thromboembolism on regression analysis. Patients with thromboembolism had longer length of stay (18.8 vs 8.9 days), more complications (41% vs 18%), and a higher risk of death (4% vs 0.9%). LIMITATIONS: This study was limited by its retrospective design and its limited generalizability to nonparticipating hospitals. CONCLUSIONS: Inflammatory bowel disease patients are at increased risk for postoperative venous thromboembolism. Reducing preoperative anemia, steroid use, malnutrition, and anesthesia time may also reduce venous thromboembolism in this at-risk population. Risk-reducing, preventative strategies are needed in this at-risk population.
KW - Chronic ulcerative colitis
KW - Crohn's disease
KW - Deep vein thrombosis
KW - Outcomes
KW - Pulmonary embolism
UR - http://www.scopus.com/inward/record.url?scp=84868579950&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84868579950&partnerID=8YFLogxK
U2 - 10.1097/DCR.0b013e3182698f60
DO - 10.1097/DCR.0b013e3182698f60
M3 - Article
C2 - 23044674
AN - SCOPUS:84868579950
SN - 0012-3706
VL - 55
SP - 1138
EP - 1144
JO - Diseases of the colon and rectum
JF - Diseases of the colon and rectum
IS - 11
ER -