title: Risk factors associated with portomesenteric venous thrombosis in patients undergoing restorative proctocolectomy for medically refractory ulcerative colitis.
abstract: OBJECTIVE
  Data on risk factors for portomesenteric venous thrombosis (PMVT) following abdominal surgery for ulcerative colitis (UC) are limited. The aim of this study was to investigate factors associated with PMVT after surgical treatment for UC.
  
  
  METHODS
  Patients who underwent restorative proctocolectomy (RPC) and ileal pouch-anal anastomosis (IPAA) including diverting ileostomy closure for medically refractory UC were identified from a prospectively maintained database. Patient-related, disease-related and treatment-related variables were collected. Univariable and multivariable analyses were performed to assess factors associated with PMVT.
  
  
  RESULTS
  Of the 521 patients completing surgical treatment for UC between 2006 and 2012, symptomatic PMVT occurred in 36 (7%), which resulted in a significantly increased hospital stay (P < 0.001). Patients developing PMVT were younger (P = 0.014), had a lower preoperative albumin level (P = 0.037) and were more likely to have been taking steroids within 1 month before surgery (P = 0.006). The combined incidence of PMVT was comparable between patients having a three-stage and two-stage management (6% vs. 8%, P = 0.43), but the relative incidence of PMVT after RPC + IPAA was 8%, significantly higher than the 4% after total abdominal colectomy (TAC) (P = 0.005) and the 2% after subsequent completion proctectomy (CP) + IPAA (P = 0.038). Multivariate analysis confirmed that RPC + IPAA was associated with a significantly greater risk of PMVT than CP + IPAA (OR = 4.9, P = 0.003) or TAC (OR = 3.5, P = 0.011). Preoperative steroid use was an independent factor for PMVT (OR = 5.8, P = 0.006).
  
  
  CONCLUSIONS
  Steroid use 1 month before surgery is associated with an increased risk of PMVT. A staged restorative proctocolectomy does not increase the overall incidence of PMVT.
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: J
authors.initials: J
authors.lastname: Gu
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: L
authors.initials: L
authors.lastname: Stocchi
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: E
authors.initials: E
authors.lastname: Gorgun
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: F H
authors.initials: FH
authors.lastname: Remzi
mesh_terms: D000328:Adult; D000367:Age Factors; D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000601:surgery*; D039021:Colonic Pouches; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects; D015994:Incidence; D007902:Length of Stay; D008297:Male; D065666:Mesenteric Ischemia / Q000453:epidemiology / Q000209:etiology*; D008642:Mesenteric Veins; D008875:Middle Aged; D015999:Multivariate Analysis; D011169:Portal Vein; D011183:Postoperative Complications; D057234:Preoperative Period; D016737:Proctocolectomy, Restorative / Q000009:adverse effects* / Q000379:methods; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D013256:Steroids / Q000009:adverse effects
chemical_list: D012709:Serum Albumin; D013256:Steroids
keywords: Portomesenteric venous thrombosis; ileal pouch-anal anastomosis; restorative proctocolectomy; ulcerative colitis