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Venous Thromboembolism After Surgery for Inflammatory Bowel Disease: Are There Modifiable Risk Factors? Data from ACS NSQIP

Wallaert, Jessica B. M.D., M.S.1; De Martino, Randall R. M.D., M.S.1,2; Marsicovetere, Priscilla S. J.D., P.A.-C.1; Goodney, Philip P. M.D., M.S.1,2; Finlayson, Sam R. G. M.D., M.P.H.1,3; Murray, John J. M.D.1,4; Holubar, Stefan D. M.D., M.S.1,4

doi: 10.1097/DCR.0b013e3182698f60
Original Contributions: Inflammatory Bowel Disease

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 (178deep 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.

1Section of General Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire

2Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire

3Center for Surgery and Public Health, Brigham & Women’s Hospital, Boston, Massachusetts

4Division of Colon and Rectal Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire

Financial Disclosures: None reported.

Podium presentation at the meeting of The American Society of Colon and Rectal Surgeons, San Antonio, TX, June 2 to 6, 2012.

Correspondence: Stefan D. Holubar, M.D., M.S., Dartmouth-Hitchcock Medical Center, One Medical Center Dr, 4C, Lebanon, NH 03766. E-mail: stefan.d.holubar@dartmouth.edu

© The ASCRS 2012