Predictors of Venous Thromboembolism after Colorectal Surgery in a Single Unit.
BACKGROUND
Patients undergoing colorectal surgery are at risk of developing venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE). Knowing predictors of VTE could help preventing this life-threatening complication.


METHODS
We collected data of patients undergoing colorectal surgery at our Unit between 2009 and 2014. Baseline characteristics, type of surgery, and postoperative complications were gathered. A univariate regression analysis was performed with symptomatic VTE as outcome. Pre-, intra- and postoperative clinical factors were separately tested. All variables significantly associated with VTE occurring within three months from the discharge were entered in the final multivariate regression model.


RESULTS
A total of 476 patients were included. Symptomatic VTE occurred in 13 patients (2.7%). Six (46.1%) occurred after hospital discharge. Preoperative variables associated with VTE were: advanced age at surgery (OR 2.3, 95%CI 1.8-5.6), smoking (OR 1.7, 95%CI 1.2-2.5), inflammatory bowel diseases (OR 2.1, 95%CI 1.5-4.3), advanced pelvic malignancies (OR 2.4, 95%CI 2.0-4.2), and obesity (OR 1.5, 95%CI 1.1-2.1). Prolonged pelvic manipulation (OR 1.8, 95%CI 1.1-4.3) and steep Trendelenburg position (OR 2.4, 95%CI 1.9-5.0) were intraoperative predictors of VTE, while stockings significantly reduced the risk (OR 0.8, 95%CI 0.4-0.9). Late mobilization (OR 2.5, 95%CI 2.0-4.6) and septic complications (OR 1.4, 95%CI 1.2-3.7) were postoperative predictors of VTE, whereas anticoagulants administered for at least 3 weeks after discharge were associated with lower VTE risk (OR 0.5, 95%CI 0.2-0.8).


CONCLUSIONS
We observed several modifiable predictors of VTE. Patients with ≥2 risk factors undergoing colorectal surgery could benefit from a more intensive VTE preventive pathway.
Department of Medical, Surgical, Neurologic, Metabolic and Ageing Sciences, Second University of Naples, Naples, Italy.
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Pellino
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Sciaudone
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Candilio
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De Fatico
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Canonico
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Selvaggi
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D003106:Colon / Q000601:surgery*; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications; D056888:Patient Positioning / Q000009:adverse effects; D010386:Pelvic Neoplasms / Q000150:complications; D011183:Postoperative Complications; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000150:complications; D012907:Smoking / Q000009:adverse effects; D053828:Stockings, Compression; D054556:Venous Thromboembolism / Q000209:etiology* / Q000517:prevention & control; D055815:Young Adult
D000925:Anticoagulants