title: Venous thromboembolism after surgery for inflammatory bowel disease: are there modifiable risk factors? Data from ACS NSQIP.
abstract: 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.
  
  
  METHODS
  We performed a retrospective review of IBD patients who underwent colorectal procedures.
  
  
  METHODS
  Patient data were obtained from the American College of Surgeons National Surgical Quality Improvement Program 2004 to 2010 Participant Use Data Files.
  
  
  METHODS
  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%).
  
  
  CONCLUSIONS
  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.affiliation: Section of General Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03766, USA.
authors.forename: Jessica B
authors.initials: JB
authors.lastname: Wallaert
authors.forename: Randall R
authors.initials: RR
authors.lastname: De Martino
authors.forename: Priscilla S
authors.initials: PS
authors.lastname: Marsicovetere
authors.forename: Philip P
authors.initials: PP
authors.lastname: Goodney
authors.forename: Sam R G
authors.initials: SR
authors.lastname: Finlayson
authors.forename: John J
authors.initials: JJ
authors.lastname: Murray
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Holubar
mesh_terms: D000328:Adult; D000758:Anesthesia / Q000009:adverse effects; D001778:Blood Coagulation Disorders / Q000150:complications; D003093:Colitis, Ulcerative / Q000601:surgery*; D016001:Confidence Intervals; D003424:Crohn Disease / Q000601:surgery*; D004630:Emergencies; D005260:Female; D006400:Hematocrit; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000150:complications; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology*; D011655:Pulmonary Embolism / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013256:Steroids / Q000009:adverse effects; D013997:Time Factors; D020246:Venous Thrombosis / Q000209:etiology*
chemical_list: D013256:Steroids