|
Back to 2014 Annual Meeting Abstracts
Risk Factors Associated With Portomesenteric Venous Thrombosis After Surgery for Medically Refractory Ulcerative Colitis
Jinyu Gu*, Luca Stocchi, Feza H. Remzi
Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, OH
Purpose: Ulcerative colitis (UC) is a predisposing factor for portomesenteric venous thrombosis (PMVT). However, data on risk factors of PMVT following abdominal surgery for UC remain limited. The aim of this study was to investigate factors associated with PMVT after surgical treatment for UC.
Methods: Patients who completed restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA) including diverting ileostomy closure for medically refractory UC were identified. Patient-related, disease-related and treatment-related variables were collected. Univariable and multivariable analyses were performed to assess factors associated with PMVT.
Results: Of the 521 patients completing surgical treatment for UC between 2006 and 2012, symptomatic PMVTs were diagnosed by CT or ultrasound in 36 patients (7%), half of whom required readmission. PMVT resulted in a significantly increased combined hospital stay (21.9 vs 14.9 days, p<0.001). The relative incidence of PMVT was 4% after total abdominal colectomy (TAC), 2% after subsequent completion proctectomy (CP) and 8% after total proctocolectomy (TPC) with IPAA (p=0.008). No PMVT occurred after stoma closure. When comparing 322 patients with 3-stage approach (initial TAC followed by CP with IPAA) versus 199 patients with 2-stage approach (initial TPC with IPAA), the combined incidence of PMVT was comparable (20 cases, 6% vs.16 cases, 8%, respectively; p= 0.43). Univariate analysis showed that patients developing PMVT were younger (33.8 vs 39.4 years old, p=0.014), had lower preoperative albumin level (3.5 vs 3.8 g/dl, p=0.037) and were more likely on steroids within a month before surgery (83% vs 59%, p=0.006). Multivariate analysis indicated that TPC was associated with a significantly greater risk of PMVT than CP (OR=6.7, p<0.001) or TAC (OR=3.8, p=0.002). Preoperative steroids remained a significant factor associated with PMVT (table). Previous history of thromboembolic disease, use of laparoscopic surgery and use of biologics were not significantly associated with the risk of postoperative PMVT.
Conclusions: PMVT often leads to readmission and prolonged hospital stay. Steroids use rather than other medications or specific surgical approaches is associated with an increased risk of PMVT . When a 3-stage approach is necessary, it does not result in an increase in overall PMVT rate. Multivariable analysis of risk factors associated with postoperative PMVT after surgery for medically refractory UC | Odds Ratio (95% Confidence Interval) | p | | Procedures | | | | TPC vs CP | 6.7 (2.6 - 17.4) | <0.001 | | TPC vs TAC | 3.8 (1.7 - 8.6) | 0.002 | | TAC vs CP | 1.8 (0. 7 - 4.6) | 0.24 | | Preoperative steroids use | 3.8 (1.5 - 9.7) | 0.006 | | Preoperative platelet count | | 0.12 | | ≤400 x 103/µL | 1 | | | > 400 x 103/µL | 1.8 (0.9 - 3. 8) | | | History of DVT and/or PE | 4.2 (0.9 - 20.1) | 0.07 | | Age at surgery | 0.9 (0.9 - 1.0) | 0.054 |
PMVT: portomesenteric venous thrombosis; UC: ulcerative colitis; TPC: total proctocolectomy; CP: completion proctectomy; TAC: total abdominal colectomy; DVT: deep vein thrombosis; PE: pulmonary embolism
Back to 2014 Annual Meeting Abstracts
|
