Venous Thromboembolism Following Colectomy for Diverticular Disease 

Abstract

Aim This study reports venous thromboembolism (VTE) rates following colectomy for diverticular disease to explore the magnitude of postoperative VTE risk in this population and identify high risk subgroups of interest. Method English national cohort study of colectomy patients between 2000–2019 using linked primary (Clinical Practice Research Datalink) and secondary (Hospital Episode Statistics) care data. Stratified by admission type, absolute incidence rates (IR) per 1,000 person-years and adjusted incidence rate ratios (aIRR) were calculated for 30- and 90-day post-colectomy VTE. Results Of 24,394 patients who underwent colectomy for diverticular disease, over half (57.39%) were emergency procedures with the highest VTE rate seen in patients ≥ 70 years-old (IR 142.27 per 1,000 person-years, 95%CI 118.32-171.08) at 30-days post colectomy. Emergency resections (IR 135.18 per 1,000 person-years, 95%CI 115.72-157.91) had double the risk (aIRR 2.07, 95%CI 1.47–2.90) of developing a VTE at 30 days following colectomy compared to elective resections (IR 51.14 per 1,000 person-years, 95%CI 38.30-68.27). Minimally invasive surgery (MIS) was shown to be protective with a 64% reduction in VTE risk (aIRR 0.36 95%CI 0.20–0.65) compared to open colectomies at 30-days post-op. At 90 days following emergency resections, VTE risks remained raised compared to elective colectomies. Conclusion Following emergency colectomy for diverticular disease, the VTE risk is approximately double compared to elective resections at 30-days while MIS was found to reduce the risk of VTE. This suggests advancements in postoperative VTE prevention in diverticular disease patients, such as extended VTE prophylaxis, should focus on those undergoing emergency colectomies, particularly in elderly patients, as well as increasing the uptake of minimally invasive techniques.