A postdischarge venous thromboembolism risk calculator for inflammatory bowel disease surgery
| Autor: | Anthony D. Yang, Ryan P. Merkow, Karl Y. Bilimoria, Michael F. McGee, David J. Bentrem, Tarik K. Yuce, Cary Jo R. Schlick |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Deep vein 030230 surgery Risk Assessment Article 03 medical and health sciences Postoperative Complications 0302 clinical medicine Risk Factors Odds Ratio medicine Humans Prospective Studies Registries Colectomy Proctectomy business.industry Anticoagulants Venous Thromboembolism Odds ratio Middle Aged Inflammatory Bowel Diseases medicine.disease Thrombosis Patient Discharge Confidence interval Surgery Pulmonary embolism medicine.anatomical_structure 030220 oncology & carcinogenesis Chemoprophylaxis Female business Body mass index |
| Zdroj: | Surgery |
| ISSN: | 0039-6060 |
| DOI: | 10.1016/j.surg.2020.09.006 |
| Popis: | Background Guidelines recommend extended chemoprophylaxis for venous thromboembolism in high-risk patients having operations for inflammatory bowel disease. Quantifying patients' risk of venous thromboembolism, however, remains challenging. We sought (1) to identify factors associated with postdischarge venous thromboembolism in patients undergoing colorectal resection for inflammatory bowel disease and (2) to develop a postdischarge venous thromboembolism risk calculator to guide prescribing of extended chemoprophylaxis. Methods Patients who underwent an operation for inflammatory bowel disease from 2012 to 2018 were identified from the American College of Surgeons National Surgical Quality Improvement Program for colectomy and proctectomy procedure targeted modules. Postdischarge venous thromboembolism included pulmonary embolism or deep vein thrombosis diagnosed after discharge from the index hospitalization. Multivariable logistic regression estimated the association of patient/operative factors with postdischarge venous thromboembolism. A postdischarge venous thromboembolism risk calculator was subsequently constructed. Results Of 18,990 patients, 199 (1.1%) developed a postdischarge venous thromboembolism within the first 30 postoperative days. Preoperative factors associated with postdischarge venous thromboembolism included body mass index (1.9% with body mass index ≥35 vs 0.8% with body mass index 18.5–24.9; odds ratio 2.34 [95% confidence interval 1.49–3.67]), steroid use (1.3% vs 0.7%; odds ratio 1.91 [95% confidence interval 1.37–2.66]), and ulcerative colitis (1.5% vs 0.8% with Crohn’s disease; odds ratio 1.76 [95% confidence interval 1.32–2.34]). Minimally invasive surgery was associated with postdischarge venous thromboembolism (1.2% vs 0.9% with open; odds ratio 1.42 [95% confidence interval 1.05–1.92]), as was anastomotic leak (2.8% vs 1.0%; odds ratio 2.24 [95% confidence interval 1.31–3.83]) and ileus (2.1% vs 0.9%; odds ratio 2.60 [95% confidence interval 1.91–3.54]). The predicted probability of postdischarge venous thromboembolism ranged from 0.2% to 14.3% based on individual risk factors. Conclusion Preoperative, intraoperative, and postoperative factors are associated with postdischarge venous thromboembolism after an operation for inflammatory bowel disease. A postdischarge venous thromboembolism risk calculator was developed which can be used to tailor extended venous thromboembolism chemoprophylaxis by individual risk. |
| Databáze: | OpenAIRE |
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