Increased risk of postoperative deep vein thrombosis and pulmonary embolism in patients with inflammatory bowel disease: a study of National Surgical Quality Improvement Program patients

Abstract

Hypothesis: Patients with inflammatory bowel disease (IBD) undergoing surgery are at increased risk for postoperative thromboembolism, including deep vein thrombosis (DVT), pulmonary embolism (PE), myocardial infarction, and stroke.

Design: Retrospective cohort study.

Setting: Two hundred eleven hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program.

Patients: All 271,368 patients from the National Surgical Quality Improvement Program 2008 Participant Use Data File were examined, and 2249 patients with IBD were compared with 269,119 patients without IBD.

Main outcome measures: Occurrence of DVT, PE, myocardial infarction, or stroke within 30 days of surgery.

Results: Of 268,703 National Surgical Quality Improvement Program patients, 2249 (0.8%) had IBD. There were 2665 cases of DVT or PE (1.0%). Occurrence of DVT or PE was more common in patients with IBD (2.5%) overall (P < .001). Nonintestinal surgical cases had a higher rate of DVT or PE (5.0%; P = .002). Regression analysis, controlling for confounders, confirmed that IBD was associated with increased risk for DVT or PE (odds ratio = 2.03; 95% CI, 1.52-2.70). For nonintestinal surgery, risk of DVT or PE for patients with IBD was increased (odds ratio = 4.45; 95% CI, 1.72-11.49). Inflammatory bowel disease had no effect on risk of postoperative myocardial infarction or stroke.

Conclusions: Patients with IBD are at increased risk for developing postoperative DVT or PE. This risk persists when potential confounding variables are controlled for. Risk of DVT or PE appears to be even higher for patients with IBD who are having nonintestinal surgery. Cardiac and stroke risks do not appear to be increased by IBD. Perhaps standards for DVT and PE prophylaxis in these cases should be reconsidered.