title: Postoperative Venous Thromboembolism in Patients Undergoing Abdominal Surgery for IBD: A Common but Rarely Addressed Problem.
abstract: 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.
  
  
  METHODS
  This was a retrospective evaluation of an administrative database.
  
  
  METHODS
  Data were obtained from Optum Labs Data Warehouse, a large administrative database containing claims on privately insured and Medicare Advantage enrollees.
  
  
  METHODS
  Seven thousand seventy-eight patients undergoing surgery for Crohn's disease or ulcerative colitis were included in the study.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Brady
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Patts
authors.forename: Amy
authors.initials: A
authors.lastname: Rosen
authors.forename: George
authors.initials: G
authors.lastname: Kasotakis
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Siracuse
authors.forename: Teviah
authors.initials: T
authors.lastname: Sachs
authors.forename: Angela
authors.initials: A
authors.lastname: Kuhnen
authors.forename: Hiroko
authors.initials: H
authors.lastname: Kunitake
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D003082:Colectomy / Q000706:statistics & numerical data; D003093:Colitis, Ulcerative / Q000601:surgery; D039021:Colonic Pouches / Q000706:statistics & numerical data; D003125:Colostomy / Q000706:statistics & numerical data; D003424:Crohn Disease / Q000601:surgery; D016208:Databases, Factual; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000601:surgery*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D011241:Prednisone / Q000627:therapeutic use; D057234:Preoperative Period; D012007:Rectum / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D005938:Glucocorticoids; D011241:Prednisone