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Are IBD Patients Underscored when Determining Postoperative VTE Risk?

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Patients with inflammatory bowel disease (IBD) have an increased risk of venous thromboembolism (VTE) following colorectal surgery and there is currently no consensus on post-surgical VTE prevention or specific VTE risk assessment tools. We sought to evaluate VTE risk after colorectal surgery and determine if known risk factors used in risk assessment tools adequate correlate with VTE risk in IBD patients.

Methods

Retrospective cohort study using the National Surgical Quality Improvement Project (NSQIP) Participant User File from 2010 to 2018.

Results

A total of 27,679 patients were included; 19,015 (68.7%) had Crohn’s disease (CD) and 8664 (31.3%) ulcerative colitis (UC). Of these, 16,749 (60.5%) underwent abdominopelvic procedures, 10,178 (36.8%) complex pelvic procedures, and 752 (2.7%) small bowel operations. The overall VTE rate was 2.3%. The VTE rate in patients with CD and UC was 1.8% and 3.6% (p < 0.001) respectively. Overall median time to VTE was 9 days after surgery. VTE rate was highest in patients who underwent complex pelvic procedures (3.6%; 361/10,178). A risk score was calculated using 16/40 available variables from the Caprini VTE Risk Assessment tool; risk score ranged from 3 to 12 points. Most patients that developed a VTE had a score between 3 and 5 points (75.6%), and only 24.5% had a score of 6 or higher. Patients with higher risk scores did not have a higher VTE incidence.

Conclusion

Post-surgical VTE rates are high in IBD patients. Over half of the events occurred following discharge and in patients with an apparent low-risk score. Additional studies are warranted to define a recommended postoperative VTE prophylaxis regimen for patients with IBD.

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Acknowledgements

To Dr. Joseph Caprini, for his guidance and help understanding the vast concept of VTE risk and use of the Caprini Risk Assessment tool.

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Authors and Affiliations

  1. Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA

    Ana Sofia Ore, Carolina Vigna, Anne Fabrizio, Thomas E. Cataldo, Evangelos Messaris & Kristen Crowell

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  1. Ana Sofia Ore
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  2. Carolina Vigna
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  3. Anne Fabrizio
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  4. Thomas E. Cataldo
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  5. Evangelos Messaris
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Corresponding author

Correspondence to Kristen Crowell.

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Conflicts of interest

The authors declare no competing interests. The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

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Ore, A.S., Vigna, C., Fabrizio, A. et al. Are IBD Patients Underscored when Determining Postoperative VTE Risk?. J Gastrointest Surg 27, 347–353 (2023). https://doi.org/10.1007/s11605-022-05525-4

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