Extended Venous Thromboembolism Prophylaxis After Elective Surgery for IBD Patients: Nomogram-Based Risk Assessment...

Area of Science:

• Surgical outcomes research
• Gastroenterology
• Vascular medicine

Background:

• Postoperative venous thromboembolism (VTE) is a serious complication for patients with inflammatory bowel disease (IBD) undergoing surgery.
• Identifying risk factors is crucial for preventing VTE and reducing associated morbidity.

Purpose of the Study:

• To identify risk factors for 30-day VTE after abdominal surgery in IBD patients.
• To determine potential indications for extended thromboprophylaxis.
• To develop a predictive nomogram for VTE risk.

Main Methods:

• Retrospective cohort study using data from the American College of Surgeons National Surgical Quality Improvement Program (2005-2016).
• Included patients with IBD undergoing elective abdominopelvic bowel surgery.
• Analyzed in-hospital and postdischarge VTE incidence within 30 days.

Main Results:

• 24,182 patients were analyzed; 30-day VTE rate was 2.5% (614/24,182), with 41% occurring postdischarge.
• Risk factors for VTE included older age, steroid use, bleeding disorders, open surgery, hypertension, longer operative time, and preoperative hospitalization.
• Factors associated with postdischarge VTE included postoperative transfusion, steroid use, specific fistula surgeries, and longer operative time.

Conclusions:

• A nomogram was developed to predict VTE risk before and after discharge.
• This tool can aid in individualized extended thromboprophylaxis decisions for IBD patients undergoing elective abdominopelvic surgery.
• The study highlights the elevated VTE risk in IBD patients and the utility of predictive models.