Do Patients With Inflammatory Bowel Disease Have a Higher Postoperative Risk of Venous Thromboembolism or Do They Undergo More High-risk Operations?

Abstract

Postoperative VTE risk varies widely by the operation performed, and a diagnostic indication of CD or UC does not play a role. Extended duration VTE prophylaxis should be considered in all patients undergoing high-risk operations, regardless of their underlying diagnosis.

Extended thromboprophylaxis following colorectal surgery in patients with inflammatory bowel disease: a comprehensive systematic clinical review

“…The three operations that were associated with the highest rate of postoperative VTE included TAC, either laparoscopic or open, segmental colectomy with colostomy and mucous fistula creation, and open TPC .Six studies identified open operations as an independent risk factor for postoperative VTE events . Similarly, six studies identified emergent operations as an independent risk factor . Longer operative time (defined as longer than 4 h) was also identified as a significant risk factor in four studies .Overall, it is clear that colorectal operations performed for IBD are associated with high risk of postoperative VTE, perhaps even independent of disease pathophysiology. What patient risk factors affect the rates of VTE in IBD patients undergoing colorectal surgery?The patient characteristics most commonly associated with increased postoperative VTE risk are age over 65 years (eight studies), chronic steroid use (eight studies) and obesity (six studies) .…”

“…right hemicolectomy, total proctocolectomy (TPC), sigmoidectomy]. Two studies compared the types of operation being performed for IBD and CRC patients . There was no significant difference between laparoscopic and open approaches or for pelvic and abdominal operations between the two groups.…”

“…Nonetheless, all IBD patients remain at an increased relative risk of VTE postoperatively and postdischarge, and therefore warrant consideration for extended pharmacological thromboprophylaxis . What surgical risk factors affect the rates of VTE in IBD patients undergoing colorectal surgery?Several studies identified specific colorectal operations that increased the risk of postoperative VTE (Table ). Operations that were associated with a high risk of postoperative VTE included proctocolectomy, TPC with ileal pouch–anal anastomosis, proctectomy, TAC with ileostomy and subtotal colectomy with colostomy or ileostomy and creation of a mucous fistula . Moreover, when discussing the factors associated with increased risk of postoperative VTE in IBD patients, McKenna et al .…”

“…Moreover, when discussing the factors associated with increased risk of postoperative VTE in IBD patients, McKenna et al . concluded that the extent of colonic resection played a larger role than the disease pathophysiology. This study also stratified colorectal operations into high, intermediate and low risk for postoperative VTE.…”

“…This study also stratified colorectal operations into high, intermediate and low risk for postoperative VTE. The three operations that were associated with the highest rate of postoperative VTE included TAC, either laparoscopic or open, segmental colectomy with colostomy and mucous fistula creation, and open TPC .Six studies identified open operations as an independent risk factor for postoperative VTE events . Similarly, six studies identified emergent operations as an independent risk factor .…”