QS211 - Incidence and Risk Factors for Venous Thromboembolism Events After Rectal Prolapse Surgery

Monday, June 3, 2024

1:54 PM – 1:57 PM ET, USA

Location: Room 327

Quick Shot Presenter(s)

SJ

Sarah Jochum, MD

Fellow
Cleveland Clinic
Cleveland Clinic
Cleveland, OH, United States

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

Author(s)

MB

Mikhael Belkovsky, MD

Colorectal Surgery Research Fellow
Department of Colorectal Surgery, Cleveland Clinic
Cleveland, Ohio, United States

Disclosure information not submitted.
RG

Rebecca Gunter, MD

Staff Surgeon
Hillcrest Hospital, Departement Colorectal Surgery, Cleveland Clinic, Cleveland Ohio
Cleveland, Ohio, United States

Disclosure information not submitted.
Stefan D. Holubar, MD, MS

Director of Research, Staff Surgeon
Department of Colorectal Surgery, Cleveland Clinic
Cleveland, Ohio, United States

Disclosure information not submitted.
Tracy L. Hull, MD

Staff Surgeon
Department of Colorectal Surgery, Cleveland Clinic
Cleveland Clinic Foundation, Lerner School of Medicine of Case Western University
Chagrin Falls, Ohio, United States

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

Arielle Kanters, MD, MS

Staff Surgeon
Department of Colorectal Surgery, Cleveland Clinic
Cleveland, Ohio, United States

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This individual has no financial relationships with ineligible companies.
AK

Ajaratu Keshinro, MD

Colorectal Surgeon
Cleveland Clinic Foundation
Cleveland, Ohio, United States

Disclosure information not submitted.
David R. Rosen, MD

Colorectal Surgeon
Cleveland Clinic
Cleveland Clinic Lerner College of Medicine
Cleveland, Ohio, United States

Disclosure information not submitted.
Anna R. Spivak, DO (she/her/hers)

Staff Surgeon
Department of Colorectal Surgery, Cleveland Clinic
Cleveland Clinic Foundation
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.
Scott Steele, MD MBA

President, Chairman, Staff Surgeon
Department of Colorectal Surgery, Cleveland Clinic
Cleveland, Ohio, United States

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This individual has no financial relationships with ineligible companies.

Senior Author(s)

Kristen A. Ban, MD

Colorectal Surgeon
Cleveland Clinic Foundation
C;leveland, Ohio, United States

Disclosure information not submitted.

Purpose/Background: The most common cause of preventable death in hospitalized patients in the United States is venous thromboembolism (VTE). While pelvic organ prolapse surgery in urogynecology literature report rates < 1%, the rate of VTE in patients undergoing rectal prolapse surgery remains largely undescribed. We sought to define the incidence and identify risk factors for VTE events in the 30-day postoperative period following surgery for rectal prolapse. We hypothesized that the rate of VTE in rectal prolapse would be low and that risk factors would include surgical approach, body mass index (BMI), smoking, and functional status.

Methods/Interventions: This study utilized the American College of Surgeons-National Surgical Quality Improvement Program between 2005-2021 using Current Procedural Terminology codes to identify rectal prolapse procedures (45130, 45505, 45541, 45540, 45550, 45402) with and without concurrent colpopexy. Demographics, BMI, operative approach, operative time, comorbidities, smoking status, American Society of Anesthesiologists (ASA) classification system scores, functional status, and VTE outcomes were collected. Bivariate analysis was performed between the groups with and without VTE. Multivariate logistic regression was used to identify independent predictors of VTE.

Results/Outcomes: A total of 19,197 rectal prolapse procedures were included and analyzed: 10,123 via perineal approach and 9,074 via transabdominal approach. Of the transabdominal surgeries, 5,887 were minimally invasive and 3,187 were open. Less than 5% (753) of the operations had concurrent colpopexy. Over half of the abdominal approach operations (5,601) were resection rectopexy. Overall, 61 (0.32%) patients developed VTE within 30 days of surgery: deep vein thrombosis (70.5%), pulmonary embolism (39.3%), and more than 60% (n=37) of the VTEs developed within two weeks of the operation. On univariate analysis (Table 1), the risk factors for VTE included ASA class of 3, 4, or 5 (p=0.01), chronic obstructive pulmonary disease (p=0.04), and dependent functional status (p=0.004). On multivariable analysis, only dependent functional status was an independent risk factor for VTE after surgery for rectal prolapse, OR 2.62 [1.31, 4.87], p=0.004.

Conclusion/Discussion: The overall incidence of VTE after rectal prolapse repair is very low, similar to that reported in the literature examining VTE after pelvic organ prolapse repair. Most VTE events occurred within the first two weeks of surgery. Thus, focus should be placed on risk reduction in the first two weeks after surgery and in patients with a dependent functional status.