Risk factors associated with portomesenteric venous thrombosis in patients undergoing restorative proctocolectomy for medically refractory ulcerative colitis

Aim Data on risk factors for portomesenteric venous thrombosis ( PMVT ) following abdominal surgery for ulcerative colitis ( UC ) are limited. The aim of this study was to investigate factors associated with PMVT after surgical treatment for UC . Method Patients who underwent restorative proctocolectomy ( RPC ) and ileal pouch‐anal anastomosis ( IPAA ) including diverting ileostomy closure for medically refractory UC were identified from a prospectively maintained database. 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 PMVT occurred in 36 (7%), which resulted in a significantly increased hospital stay ( P  <   0.001). Patients developing PMVT were younger ( P  =   0.014), had a lower preoperative albumin level ( P  =   0.037) and were more likely to have been taking steroids within 1 month before surgery ( P  =   0.006). The combined incidence of PMVT was comparable between patients having a three‐stage and two‐stage management (6% vs 8%, P  =   0.43), but the relative incidence of PMVT after RPC  +  IPAA was 8%, significantly higher than the 4% after total abdominal colectomy (TAC) ( P  =   0.005) and the 2% after subsequent completion proctectomy (CP) +  IPAA ( P  =   0.038). Multivariate analysis confirmed that RPC  +  IPAA was associated with a significantly greater risk of PMVT than CP +  IPAA ( OR  = 4.9, P  =   0.003) or TAC ( OR  = 3.5, P  =   0.011). Preoperative steroid use was an independent factor for PMVT ( OR  = 5.8, P  =   0.006). Conclusion Steroid use 1 month before surgery is associated with an increased risk of PMVT . A staged restorative proctocolectomy does not increase the overall incidence of PMVT .