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The Importance of Extended Postoperative Venous Thromboembolism Prophylaxis in IBD: A National Surgical Quality Improvement Program Analysis

Gross, Molly E. M.D.1; Vogler, Sarah A. M.D.1; Mone, Mary C. R.N., B.S.E.1; Sheng, Xiaoming Ph.D.2; Sklow, Bradford M.D.1

Diseases of the Colon & Rectum:
doi: 10.1097/DCR.0000000000000090
Original Contributions: Inflammatory Bowel Disease
Abstract

BACKGROUND: The National Comprehensive Cancer Network recommends that patients who have colorectal cancer receive up to 4 weeks of postoperative out-of-hospital venous thromboembolism prophylaxis. Patients with IBD are at high risk for venous thromboembolism, but there are no recommendations for routine postdischarge prophylaxis.

OBJECTIVE: The purpose of this study was to compare the postoperative venous thromboembolism rate in IBD patients versus patients who have colorectal cancer to determine if IBD patients warrant postdischarge thromboembolism prophylaxis.

DESIGN: This study is a retrospective review of IBD patients and patients who had colorectal cancer who underwent major abdominal and pelvic surgery.

PATIENTS: Data were collected from the American College of Surgeons National Surgical Quality Improvement Program (2005–2010).

MAIN OUTCOME MEASURES: The primary outcome was 30-day postoperative venous thromboembolism in IBD patients and patients who had colorectal cancer. Risk factors for venous thromboembolism were analyzed with the use of univariate testing and stepwise logistic regression.

RESULTS: A total of 45,964 patients were identified with IBD (8888) and colorectal cancer (37,076). The 30-day postoperative rate of venous thromboembolism in IBD patients was significantly higher than in patients who had colorectal cancer (2.7% vs 2.1%, p < 0.001). In a model with 15 significant covariates, the OR for venous thromboembolism was 1.26 (95% CI, 1.021–1.56; p = 0.03) for the IBD patients in comparison with the patients who have colorectal cancer.

LIMITATIONS: This study was limited by the retrospective design and the limitations of the data included in the database.

CONCLUSIONS: Patients with IBD had a significantly increased risk for postoperative venous thromboembolism in comparison with patients who had colorectal cancer. Therefore, postdischarge venous thromboembolism prophylaxis recommendations for IBD patients should mirror that for patients who have colorectal cancer. This would suggest a change in clinical practice to extend out-of-hospital prophylaxis for 4 weeks in postoperative IBD patients.

In Brief

See related Editorial on p. 413

Author Information

1Department of Surgery, University of Utah, Salt Lake City, Utah

2Department of Pediatrics, University of Utah, Salt Lake City, Utah

Financial Disclosure: None reported.

Presented at the meeting of the American Society of Colon and Rectal Surgeons, Phoenix, AZ, April 27 to May 1, 2013.

Correspondence: Bradford Sklow, M.D., Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132. E-mail: bradford.sklow@hsc.utah.edu

© 2014 The American Society of Colon and Rectal Surgeons