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Postoperative Venous Thromboembolism in Patients Undergoing Abdominal Surgery for IBD

A Common but Rarely Addressed Problem

Brady, Matthew T., M.D.; Patts, Gregory J., M.P.H.; Rosen, Amy, Ph.D.; Kasotakis, George, M.D., M.P.H.; Siracuse, Jeffrey J., M.D.; Sachs, Teviah, M.D., M.P.H.; Kuhnen, Angela, M.D.; Kunitake, Hiroko, M.D.

Diseases of the Colon & Rectum: January 2017 - Volume 60 - Issue 1 - p 61–67
doi: 10.1097/DCR.0000000000000721
Original Contributions: Inflammatory Bowel Disease
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BACKGROUND: Venous thromboembolism after abdominal surgery occurs in 2% to 3% of patients with Crohn’s disease and ulcerative colitis. However, no evidence-based guidelines currently exist to guide postdischarge prophylactic anticoagulation.

OBJECTIVE: We sought to determine the use of postoperative postdischarge venous thromboembolism chemical prophylaxis, 90-day venous thromboembolism rates, and factors associated with 90-day thromboembolic events in IBD patients following abdominal surgery.

DESIGN: This was a retrospective evaluation of an administrative database.

DATA SOURCE: Data were obtained from Optum Labs Data Warehouse, a large administrative database containing claims on privately insured and Medicare Advantage enrollees.

PATIENTS: Seven thousand seventy-eight patients undergoing surgery for Crohn’s disease or ulcerative colitis were included in the study.

MAIN OUTCOME MEASURES: Primary outcomes were rates of postdischarge venous thromboembolism prophylaxis and 90-day rates of postdischarge thromboembolic events. In addition, patient clinical characteristics were identified to determine predictors of postdischarge venous thromboembolism.

RESULTS: Postdischarge chemical prophylaxis was given to only 0.6% of patients in the study. Two hundred thirty-five patients (3.3%) developed a postdischarge thromboembolic complication. Postdischarge thromboembolism was more common in patients with ulcerative colitis than with Crohn’s disease (5.8% vs 2.3%; p < 0.001). Increased rates of venous thromboembolism were seen in patients undergoing colectomy or proctectomy with simultaneous stoma creation compared with colectomy or proctectomy alone (5.8% vs 2.1%; p < 0.001). The strongest predictors of thromboembolic complications were stoma creation (adjusted OR, 1.95; 95% CI, 1.34–2.84), J-pouch reconstruction (adjusted OR, 2.66; 95% CI, 1.65–4.29), preoperative prednisone use (adjusted OR, 1.57; 95% CI, 1.19–2.08), and longer length of stay (adjusted OR, 1.89; 95% CI, 1.41–2.52).

LIMITATIONS: This study is limited by its retrospective design.

CONCLUSIONS: The use of postdischarge venous thromboembolism prophylaxis in this patient sample was infrequent. Development of evidence-based guidelines, particularly for high-risk patients, should be considered to improve the outcomes of IBD patients undergoing abdominal surgery.

1 Department of Surgery, Boston University School of Medicine, Boston, Massachusetts

2 Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts

3 Optum Visiting Fellow, Boston University School of Medicine, Boston, Massachusetts

Funding/Support: Internal funding, Department of Surgery, Boston University School of Medicine.

Financial Disclosures: None reported.

Podium presentation at the meeting of the American Society of Colon and Rectal Surgeons, Los Angeles, CA, April 30 to May 4, 2016.

Correspondence: Matthew T. Brady, M.D., 88 East Newton St, C515, Boston, MA, 02118. E-mail: matthew.t.brady.md@gmail.com

© 2017 The American Society of Colon and Rectal Surgeons