Document Detail


Venous thromboembolism after surgery for inflammatory bowel disease: are there modifiable risk factors? Data from ACS NSQIP.
MedLine Citation:
PMID:  23044674     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Jessica B Wallaert; Randall R De Martino; Priscilla S Marsicovetere; Philip P Goodney; Sam R G Finlayson; John J Murray; Stefan D Holubar
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Diseases of the colon and rectum     Volume:  55     ISSN:  1530-0358     ISO Abbreviation:  Dis. Colon Rectum     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-10-09     Completed Date:  2012-12-21     Revised Date:  2014-04-14    
Medline Journal Info:
Nlm Unique ID:  0372764     Medline TA:  Dis Colon Rectum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1138-44     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Anesthesia / adverse effects
Blood Coagulation Disorders / complications
Colitis, Ulcerative / surgery*
Confidence Intervals
Crohn Disease / surgery*
Emergencies
Female
Hematocrit
Humans
Male
Malnutrition / complications
Middle Aged
Multivariate Analysis
Odds Ratio
Postoperative Complications / etiology*
Pulmonary Embolism / etiology*
Retrospective Studies
Risk Factors
Steroids / adverse effects
Time Factors
Venous Thrombosis / etiology*
Grant Support
ID/Acronym/Agency:
K08 HL105676/HL/NHLBI NIH HHS; L32 MD006323/MD/NIMHD NIH HHS
Chemical
Reg. No./Substance:
0/Steroids
Comments/Corrections
Comment In:
Nat Rev Gastroenterol Hepatol. 2013 Jan;10(1):5-6   [PMID:  23183789 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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