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Emergency colectomies in the NOAC era: a nationwide analysis demonstrating increased complications

  • 2021 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

The use of Non-vitamin K antagonist oral anticoagulants (NOAC) has increased substantially since their introduction in 2010. The lack of readily available reversal agents poses a challenge in perioperative management. The aim of this study was to evaluate the impact of NOACs on the outcomes of emergency colectomies.

Methods

All adult patients on long-term anticoagulation who underwent emergency colectomies were identified from the Nationwide Inpatient Sample (NIS) database from 2002 to 2018. Long-term anticoagulation was defined using ICD-9/10 codes. Two cohorts were compared: anticoagulated patients in the pre-NOAC era (2002–2010) and anticoagulated patients in the NOAC era (2010–2018). Outcomes of interest were postoperative surgical complications, mortality and need for transfusion.

Results

Of 13,218 patients on long-term anticoagulation, 3,264 patients were treated in the pre-NOAC era and 9,954 in the NOAC era. Over the study period, there was a significant increase in the proportion of anticoagulated patients undergoing emergency colectomies (R2 = 0.91). On univariate analysis, anticoagulated patients in the NOAC era were medically more comorbid and had higher rates of postoperative surgical complications (73.3% vs 60.3%, p < 0.001) and mortality (8.2% vs. 6.7%, p = 0.006), but had lower rates of postoperative bleeding (3.5% vs. 4.4%, p = 0.002) and transfusions (38.1% vs. 45.4%, p < 0.001). On multivariable regression, after accounting for clinically significant covariates, anticoagulation in the NOAC era was associated with decreased rates of postoperative bleeding (OR 0.70, 95%CI 0.57–0.88) and transfusions (OR 0.71 95%CI 0.64–0.77) but remained an independent predictor of increased overall postoperative complications (OR 1.26, 95%CI 1.14–1.39).

Conclusion

Prevalence of long-term anticoagulation in patients undergoing emergency colectomies is increasing. Although associated with lower rates of postoperative bleeding and transfusions, anticoagulation in the NOAC era is associated with higher rates of overall postoperative complications. Evidence-based guidelines for perioperative management of patients on NOACs in the emergency colorectal surgery setting are needed.

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Acknowledgements

The authors thank Sarah Faris-Sabboobeh, Georgia Rigas, and Marie Demian for their administrative assistance.

Funding

There is no grant support or funding for the study.

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Author notes

  1. Jeongyoon Moon and Maryam AlFarsi have Co-first author.

Authors and Affiliations

  1. Department of Surgery, McGill University, Montreal, QC, Canada

    Jeongyoon Moon, Maryam AlFarsi, Daniel Marinescu, Mohammed AlQahtani, Allison Pang, Gabriela Ghitulescu, Carol-Ann Vasilevsky & Marylise Boutros

  2. Division of Colon and Rectal Surgery, Jewish General Hospital, McGill University, 3755 Cote Ste Catherine, Room G-308, Montreal, QC, H3T 1E2, Canada

    Marylise Boutros

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  1. Jeongyoon Moon
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Contributions

All authors contributed to the design of the study. JM, MA, DM, MA, MB participated in data acquisition. JM, MA, DM, MA, AP, GG, CAV, MB participated in data analysis and interpretation. JM, MA, and MB prepared the first draft of the manuscript. All authors contributed to, and approved, the final version of the manuscript.

Corresponding author

Correspondence to Marylise Boutros.

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Disclosures

Drs. Jeongyoon Moon, Maryam Al Farsi, Allison Pang, Gabriela Ghitulescu, and Carol-Ann Vasilevsky, have no conflicts of interest or financial ties to disclose. Dr. Marylise Boutros received teaching honorarium from Johnson and Johnson. Daniel Marinescu and Mohammed AlQahtani have no conflicts of interest or financial ties to disclose.

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Moon, J., AlFarsi, M., Marinescu, D. et al. Emergency colectomies in the NOAC era: a nationwide analysis demonstrating increased complications. Surg Endosc 37, 660–668 (2023). https://doi.org/10.1007/s00464-022-09630-y

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