SS100 - Venous Thromboembolism Prophylaxis Practice Patterns, Outcomes, and Risk Stratification after Surgery for Inflammatory Bowel Disease: A NSQIP IBD Collaborative Study

Saturday, May 10, 2025

3:11 PM – 3:17 PM PT

Location: Ballroom 6C-F, Upper Level

Presenting Author(s)

Stefan D. Holubar, MD, MS, FACS, FASCRS

Director of Research
Cleveland Clinic
Cleveland, Ohio, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no relevant relationships with ineligible companies.

Author(s)

SE

Samuel Eisenstein, MD

Associate Professor
UC San Diego Health
La Jolla, California, United States

All of the relevant financial relationships listed below have been mitigated.
Takeda: Consultant (Ongoing)
Liliana Bordeianou, MD, FASCRS

MD
Massachusetts General Hospital, Harvard Medical School
Harvard
Boston, Massachusetts, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no relevant relationships with ineligible companies.
WC

William C. Chapman, Jr., MD

Assistant Professor
Washington University School of Medicine
St. Louis, Missouri, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
KC

Kristen Crowell, MD

Assistant Professor of Surgery
Division of Colon and Rectal Surgery, Beth Isreal Deaconess Medical Center
Boston, Massachusetts, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
EL

Edward Lee, MD

Chief of the Division of General Surgery
Albany Medical Center
Albany, New York, United States

Disclosure information not submitted.
Kinga S. Olortegui, MD, MS, FACS

Assistant Professor
UChicago Medicine
Chicago, Illinois, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
JS

Julia T. Saraidaridis, MD, MMSc

Assistant Professor of Surgery, Tufts University School of Medicine
Lahey Clinic
Burlington, Massachusetts, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
JS

Jeffrey S. Scow, MD

Associate Professor of Surgery
Penn State Milton S. Hershey Medical Center, Division of Colon and Rectal Surgery
Hershey, Pennsylvania, United States

Disclosure information not submitted.
MP

Michael C. Plietz, MD (he/him/his)

Assistant Professor of Surgery
Icahn School of Medicine at Mount Sinai
New York, NY, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

Stefan D. Holubar, MD, MS, FACS, FASCRS: This individual has no relevant relationships with ineligible companies.

Samuel Eisenstein, MD: Takeda: Consultant (Ongoing)

Liliana Bordeianou, MD, FASCRS: This individual has no relevant relationships with ineligible companies.

William C. Chapman, MD, Jr.: This individual has no financial relationships with ineligible companies.

Kristen Crowell, MD: This individual has no financial relationships with ineligible companies.

Kinga S. Olortegui, MD, MS, FACS: This individual has no financial relationships with ineligible companies.

Julia T. Saraidaridis, MD, MMSc: This individual has no financial relationships with ineligible companies.

Michael C. Plietz, MD: This individual has no financial relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: The aim of this study was to investigate the real-world efficacy of venous thromboembolism (VTE) chemoprophylaxis (PPx) strategies in patients undergoing surgery for IBD; we hypothesized PPx with low molecular weight heparin (LMWH) was protective. The secondary aim was to report rates of clinically significant bleeding of each VTE PPx strategy. Finally, a clinical risk stratification score was developed.

Methods/Interventions: From July 2020 to October 2023, the National Surgical Quality Improvement Program IBD Collaborative collected an additional 5 VTE variables: type of inpatient and post-discharge extended PPx (ePPx), prophylaxis duration, bleeding complications, and VTE location at 17 hospitals. Patients with IBD who underwent colectomy or proctectomy who were eligible for inpatient and discharge prophylaxis (i.e. no preoperative or postoperative anti-platelet or anticoagulation therapy) without missing PPx data were included. All VTEs cases were validated by surgeons at the respective centers. Univariate statistics are reported. Multivariable logistic regression models for independent predictors of VTE were performed.

Results/Outcomes: A total of 1,822 patients at 17 centers were eligible for VTE chemo-PPx and analyzed, of whom 44 (2.4%) developed VTE within 30-days of surgery: 22 (50%) before discharge, and 22 (50%) after discharge. VTEs occurred at a median of 9 (IQR, 4 - 15) days postoperatively. VTE distribution: portomesenteric vein in 17 (38%), pulmonary embolism in 9 (20.5%), upper and lower extremity in 7 and 4 (16% and 11.3%) respectively, and >1 site/other in 7 (15.9%). The mean postoperative length of stay was longer in patients with VTE compared to no VTE (11.4 vs. 6.9 days, p< 0.0001). The 30-day mortality was higher in patients with VTE compared to no VTE (4.6% vs. 0.23%, p=0.008). Overall, the most common inpatient PPx (Table 1) was LMWH (48.5%), followed by unfractionated heparin (UFH, 42.8%), followed by no chemo-PPx (No PPx, 8.7%). Prior to discharge VTE rates by PPx strategy (excluding post-discharge VTEs) were significantly different (LMWH, 0.57%, SQH 2.1%, No PPX, 0%, p=0.006). After discharge without VTE, ePPx strategies included No ePPx (49.6%), LMWH (43.8%), prophylactic dose direct oral anticoagulants (DOAC, 4.3%), aspirin (ASA, 1.4%), and UFH (0.9%). Post-discharge VTE rates were significantly different by ePPx strategy: ASA (7.7%), UFH (5.9%), DOAC (2.6%), No ePPx (1.4%), and LMWH (0.63%), p=0.004. VTE prophylaxis was not associated with clinically significant bleeding complications (Table 1). A multivariable model for any postoperative VTE (before or after discharge) revealed preoperative systemic inflammatory response syndrome (SIRS, p=0.0005) and extended resections (total colectomy or proctocolectomy, p< 0.0001) were independently associated with VTE (Table 2). Patients with 0, 1, or 2 risk factors had observed VTE rates of 1.2%, 4.0%, and 13.9%; p< 0.0001. Inpatient and extended PPx with LWHM were independently associated with a lower risk of VTE before and after discharge, (p=0.02 and p=0.03), respectively (Table 2).

Conclusion/Discussion: After surgery for IBD, VTE prophylaxis with LMWH was independently associated with decreased VTE risk before and after discharge. Prophylaxis strategies were not associated with bleeding complications. A risk score based on 2 variables stratified patients into low-, moderate-, and high-risk VTE categories. Patients at highest risk (preoperative SIRS, extended resections) may benefit the most from extended VTE chemoprophylaxis.