eP256 - Venothromboembolic Events in Inflammatory Bowel Disease Patients Are Associated with the Need for Surgery

ePoster Presenter(s)

• 

  Saher-Zahra Khan, MD

  Resident, General Surgery
  University Hospitals Cleveland Medical Center / Case Western Reserve University
  University Hospitals Cleveland Medical Center
  Cleveland, OH, United States

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

Senior Author(s)

• 

  Emily Steinhagen, MD (she/her/hers)

  Associate Professor
  University Hospitals Cleveland Medical Center
  University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no financial relationships with ineligible companies.

Author(s)

• VN

  Vu Q. Nguyen, M.D., M.S.

  Assistant Professor of Medicine
  University Hospitals Cleveland Medical Center
  Cleveland, Ohio, United States

  Disclosure information not submitted.
• JP

  Jaime Abraham Perez, Ph.D

  Biostatistician
  University Hospitals
  Cleveland, Ohio, United States

  Disclosure information not submitted.
• EH

  Elleson Harper, n/a

  Clinical Research Business Development Liaison I
  University Hospitals
  Massillon, Ohio, United States

  Disclosure information not submitted.
• 

  Jennifer L. Miller-Ocuin, MD

  Assistant Professor of Surgery
  Case Western Reserve - University Hospitals
  University Hospitals - Case Western
  Cleveland, OH, United States

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

  David Dietz, MD, MHCDS, FASCRS

  Vice President System Surgery Value and Transformation
  University Hospitals
  Cleveland, Ohio, United States

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no financial relationships with ineligible companies.
• 

  Alicia Adams, MD (she/her/hers)

  Fellow
  University Hospitals
  University Hospitals
  Cleveland, OH, United States

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

  Ronald Charles, M.D.

  Colorectal surgeon, Assistant Professor of Surgery
  University Hospitals Cleveland Medical Center / Case Western Reserve University
  Cleveland, Ohio, United States

  Disclosure information not submitted.
• 

  Sami Kishawi, MD

  General Surgery Resident
  University Hospitals Cleveland Medical Center
  University Hospitals Cleveland Medical Center
  Cleveland, OH, United States

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

  Jonathan Bliggenstorfer, MD

  General Surgery Resident
  University Hospitals Cleveland Medical Center
  Cleveland, Ohio, United States

  Disclosure information not submitted.

Purpose/Background: Factors associated with increased likelihood of surgery in inflammatory bowel disease (IBD) patients include longer disease duration, disease distribution (ileocolic, perianal), and previous surgical intervention. Additionally, IBD is a well-known risk factor for venothromboembolism (VTE) due to the procoagulable impact of uncontrolled inflammation. We hypothesize that VTE suggests the presence of systemic inflammation that is not responding to medical management and is associated with a need for surgical intervention. We aim to investigate whether VTE suggest the need for surgical intervention in IBD patients.Methods/Interventions: TriNetX is an electronic health record network from 70 health care organizations in the United States. Two cohorts were created within the platform using ICD-10 codes; one of IBD patients with no history of VTE, and one of IBD patients with VTE. Demographics, comorbidities, and medication prescriptions (using RxNorm codes) were compared between the cohorts. We conducted a propensity score-matched (PSM) analysis to predict the outcomes of interest including abdominal surgery within 1 year (using CPT codes for various intestinal and colonic surgeries) and mortality within 1 year. We matched for age, sex, smoking, comorbidities, and medications. Chi-squared test for categorical variables and t-test for continuous variables were used to compare cohorts. Odds ratios (OR) with 95% confidence intervals are reported for outcomes.Results/Outcomes: Prior to PSM, 241,813 patients were in the IBD without VTE cohort (nVTE) and 10,639 in the IBD with VTE (yVTE) cohort. After PSM, 10,633 were in each cohort with a mean age was 57.2; 47.2% were male, and 78.1% were White. Average BMI was 27.7 for all patients and 15% smoked. Biologic use was similar between the two cohorts and after PSM, more patients in the yVTE group used immunomodulators, prednisone, dexamethasone, and hydrocortisone. More patients in the yVTE group had cardiovascular disease after PSM. 565 (5.3%) of yVTE patients and 245 (2.3%) of nVTE patients underwent surgery within one year (OR 2.38, 95% CI 2.04-2.77). 1028 (9.7%) of yVTE patients and 296 (2.8%) of nVTE patients suffered mortality within one year (OR 3.74, 95% CI 3.74-4.27).Conclusion/

Discussion: The likelihood of abdominal surgery and mortality within 1 year in IBD patients after VTE is 138% and 274% higher, respectively, compared to IBD patients without VTE. This suggests the possibility that VTE signifies a high level of inflammation that may require surgical intervention within a year."Table 1Comparison of demographics, comorbidities, and medications between IBD patients with and without VTE after propensity score matching. Significant p-values are bolded. Table 2Outcomes between IBD patients with and without VTE with odds ratios and 95% confidence intervals.""Table 1

Comparison of demographics, comorbidities, and medications between IBD patients with and without VTE after propensity score matching. Significant p-values are bolded.
Table 2

Outcomes between IBD patients with and without VTE with odds ratios and 95% confidence intervals."