Multiple Risk Factors Increase Risk for VTE After Surgery for IBD

Stefan David Holubar, MD

New research found that perioperative and operative risk factors increase the risk of venous thromboembolism (VTE) after surgery for inflammatory bowel disease (IBD).

From a novel model presented by investigators at the 2022 Digestive Disease Week Annual Meeting, the presence of more than 5 study risk factors saw the cumulative risk increase exponentially.

“This study affirms that multiple perioperative and operative factors increase the risk of VTE after surgery for IBD,” wrote study author Stefan David Holubar, MD, Cleveland Clinic.

There is a recognized risk for VTE in patients undergoing colorectal surgery for IBD. As such, investigators aimed to determine the perioperative risk factors for VTE, as well as create a predictive scoring system for VTE in the IBD cohort.

Holubar and colleagues used the NSQIP-IBD registry from 2017-2020 to identify patients and analyze demographics, operative and outcomes data of IBD patients undergoing colectomies for IBD. Further, study t and x^2 tests were used for univariate analysis, while a logistic multivariate regression model was conducted using all significant variables to develop a predictive scoring system of VTE.

A total of 5003 patients (51.9% male, mean age 42.7 years) were included in the study. The population was made up of 57.3% patients with Crohn’s and 42.7% patients with ulcerative colitis.

Investigators observed on multivariate analysis ASA grade, these 5 risk factors were associated with greater risk of VTE, with the highest odds for an open abdomen postoperatively:

• Ulcerative colitis (odds ratio [OR], 1.72, 1.13 - 2.63; P = .011)
• Sepsis (OR, 2.28, 1.38 - 3.68; P = .001)
• Serum sodium <139 mmol/L (OR, 1.66, 1.08 - 2.56; P = .022)
• Open abdomen (OR, 2.69, 1.20 - 5.39, P = .009)
• Perioperative interhospital transfer (OR, 2.49, 1.52 - 3.98; P <.001)

From this, a risk model was created by investigators. Data show the risk of VTE with a single risk factor was 0.7% and 1.8% with two risk factors. Then, the risk increased to 3.6% and 4.5% with three and four risk factors, respectively.  At 5 risk factors, the risk increased exponentially to 10.9% and at 6 risk factors, the risk increased to 25%.

Investigators noted that 11.4% of patients were discharged with chemoprophylaxis, but this did not impact the rate of developing VTE (3.3% vs 2.39%; P = .17).

The study, “Risk of Venous Thromboembolism After Surgery for Inflammatory Bowel Disease: The NSQIP-IBD Registry Analysis,” was presented at DDW 2022.