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Ulcerative Colitis Is Associated With an Increased Risk of Venous Thromboembolism in the Postoperative Period: The Results of a Matched Cohort Analysis

Wilson, Matthew Z. MD, MS*; Connelly, Tara M. MB, BCh, MS; Tinsley, Andrew MD; Hollenbeak, Christopher S. PhD†,§; Koltun, Walter A. MD; Messaris, Evangelos MD, PhD

doi: 10.1097/SLA.0000000000000788
Original Articles

Objectives: To determine the rates of venous thromboembolism (VTE) during admission and within 30 days of hospital discharge in inflammatory bowel (IBD) patients undergoing colonic resection using the ACS National Surgical Quality Improvement Project (NSQIP) database and to compare these rates to VTE rates in cohorts of patients undergoing colonic resection for several other colonic pathologies.

Background: High rates of VTE have been demonstrated in hospitalized IBD patients. However, rates of postdischarge VTE in IBD patients are understudied.

Methods: Demographic, operative, and outcomes data for 96,999 patients undergoing colonic resection for diverticulitis, colorectal cancer (CRC), benign neoplasms, ulcerative colitis (UC), and Crohn's disease (CD) between 2005 and 2011 was obtained. Student t and χ2 tests were used for univariate analysis. A logistic multivariate analysis was performed with all significant variables. Propensity score matching was utilized to compare the VTE incidences between the groups.

Results: Highest VTE risk was seen in obese patients [odds ratio (OR) = 1.41], those older than 73 years (OR = 1.58) and with bleeding disorders (OR = 1.44), American Society of Anesthesiology class III/IV (OR = 1.52/1.86), preoperative systemic inflammatory response syndrome (OR = 1.55), sepsis (OR = 1.48) or steroid use (OR = 1.63), and primary diagnosis of UC (OR = 2.10). The UC group had the highest incidence of VTE (2.74%), followed by CRC patients (1.74%). A 1.2% incidence was seen in the CD population, and 41.5% of the UC-VTEs were diagnosed after discharge.

Conclusions: This study affirms that inpatient UC patients undergoing colonic resection are at high risk for VTE and suggests that this risk persists into the postdischarge period. Thus, these patients should be given appropriate prophylaxis.

Using National Surgical Quality Improvement Program data from 96,999 patients undergoing colonic resections, this study demonstrates an increased risk of venous thromboembolism (VTE) in surgical ulcerative colitis (UC) patients. The risk was demonstrated to be greater than that of patients undergoing surgery for colorectal cancer (2.7 vs 1.7%). UC patients had the highest number of postdischarge VTEs (42%).

*Department of Surgery

Division of Colon and Rectal Surgery

Division of Gastroenterology, Inflammatory Bowel Disease Center, Department of Surgery; and

§Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA.

Reprints: Evangelos Messaris, MD, PhD, College of Medicine, Department of Surgery, The Pennsylvania State University, 500 University Drive, H137, Hershey, PA 17033. E-mail:

Disclosure: The authors declare no conflicts of interest.

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