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Risk factors associated with portomesenteric venous thrombosis in patients undergoing restorative proctocolectomy for medically refractory ulcerative colitis
Author(s) -
Gu J.,
Stocchi L.,
Gorgun E.,
Remzi F. H.
Publication year - 2016
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.13275
Subject(s) - medicine , ulcerative colitis , proctocolectomy , colectomy , gastroenterology , ileostomy , incidence (geometry) , refractory (planetary science) , risk factor , surgery , anastomosis , disease , physics , astrobiology , optics
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 .