Format

Send to

Choose Destination
See comment in PubMed Commons below
Dis Colon Rectum. 2012 Nov;55(11):1138-44. doi: 10.1097/DCR.0b013e3182698f60.

Venous thromboembolism after surgery for inflammatory bowel disease: are there modifiable risk factors? Data from ACS NSQIP.

Author information

  • 1Section of General Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03766, USA.

Abstract

BACKGROUND:

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.

Comment in

[PubMed - indexed for MEDLINE]
Free PMC Article
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Lippincott Williams & Wilkins Icon for PubMed Central
    Loading ...
    Write to the Help Desk