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Surgery and the Subtype of Inflammatory Bowel Disease Impact the Risk of Venous Thromboembolism After Hospital Discharge

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Abstract

Background

Surgery for inflammatory bowel disease (IBD) is associated with an increased risk of venous thromboembolism (VTE) during hospitalization. It is unclear whether this association persists after hospital discharge.

Aims

We assessed the association between surgery and VTE following hospital discharge in IBD.

Methods

We conducted a population-based cohort study between 2002 and 2016 in Ontario, Canada. Adults with IBD hospitalized for ≥ 72 h who underwent an intra-abdominal surgery were compared to hospitalized, nonsurgical IBD patients. Multivariable Cox proportional hazard models were used to compare VTE risk within 12 months of discharge.

Results

A total of 80,445 hospital discharges were analyzed: 60% Crohn’s disease (CD) and 40% ulcerative colitis (UC). The median time to VTE was three times longer for nonsurgical patients with CD and 1.6 times longer for nonsurgical patients with UC. Compared with nonsurgical patients, surgery for CD was associated with a lower cumulative risk of VTE in the 2 weeks after discharge and persisted through to 12 months after discharge (adjusted HR 0.24; 95% CI 0.15–0.40). In contrast, urgent surgery for UC was associated with an increased risk of VTE. The increased risk was greatest at 2 weeks after discharge (aHR, 1.80; 95% CI 1.26–2.57) and declined progressively over the course of 12 months.

Conclusions

Surgery was associated with a greater risk of VTE after hospital discharge in UC but not CD. In patients with UC who have undergone urgent surgery, healthcare providers should consider an extended period of prophylaxis after hospital discharge.

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Acknowledgments

This work was supported by an institutional grant from the University of Ottawa, Department of Medicine. This study was also supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). Parts of this material are based on data compiled and provided by: the Ontario MOHLTC, CIHI, and Cancer Care Ontario. The analyses, conclusions, opinions and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred.

Eric Benchimol was supported by a New Investigator Award from the Canadian Institutes of Health Research, Canadian Association of Gastroenterology and Crohn’s and Colitis Canada. Eric Benchimol was also supported by the Career Enhancement Program of the Canadian Child Health Clinician Scientist Program. Ellen Kuenzig was supported by a Mitacs Elevate Postdoctoral Fellowship.

Funding

This study was funded in full by an institutional grant from the University of Ottawa, Department of Medicine.

Author information

Authors and Affiliations

  1. Department of Medicine, University of Ottawa, Ottawa, Canada

    Jeffrey D. McCurdy, Oliver W. Fung, Sanjay K. Murthy & Marc Carrier

  2. The Ottawa Hospital Research Institute, Ottawa, Canada

    Jeffrey D. McCurdy, Ranjeeta Mallik, Lara Williams, Sanjay K. Murthy & Marc Carrier

  3. CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology Hepatology and Nutrition, Children’s Hospital of Eastern Ontario, Ottawa, Canada

    M. Ellen Kuenzig & Eric I. Benchimol

  4. ICES uOttawa, Ottawa, Canada

    M. Ellen Kuenzig, Sarah Spruin & Eric I. Benchimol

  5. Department of Surgery, University of Ottawa, Ottawa, Canada

    Lara Williams

  6. Department of Medicine, University of Toronto, Toronto, Canada

    Geoff Nguyen & Eric I. Benchimol

  7. Division of Gastroenterology, Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Toronto, Canada

    Geoff Nguyen

Authors
  1. Jeffrey D. McCurdy
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  2. M. Ellen Kuenzig
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  5. Ranjeeta Mallik
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  6. Lara Williams
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  7. Sanjay K. Murthy
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  8. Marc Carrier
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  9. Geoff Nguyen
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  10. Eric I. Benchimol
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Contributions

JM designed the study, interpreted the data and drafted manuscript. EB and EK designed the study, interpreted the data, and critically reviewed the manuscript. OF performed data collection and critical review of manuscript. GN, SM, LW, and MC interpreted the data and critically reviewed the manuscript. SS and RM analyzed and interpreted the data.

Corresponding author

Correspondence to Jeffrey D. McCurdy.

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Conflict of interest

JM: Consultancy fees and/or Honoraria: Jannsen, AbbVie, Takeda, Pfizer. SM: Consultancy fees and/or Honoraria: Jannsen, AbbVie, Takeda, Pfizer. MC: Research funding: BMS, Pfizer and Leo Pharma, Honoraria: Bayer, Pfizer, Sanofi, BMS, Servier and Leo Pharma. All other authors have no conflict of interest to declare. The writing and preparation of this paper was conducted by the primary author. There was no writing support.

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McCurdy, J.D., Ellen Kuenzig, M., Spruin, S. et al. Surgery and the Subtype of Inflammatory Bowel Disease Impact the Risk of Venous Thromboembolism After Hospital Discharge. Dig Dis Sci 67, 2471–2479 (2022). https://doi.org/10.1007/s10620-021-07064-5

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  • DOI: https://doi.org/10.1007/s10620-021-07064-5

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