Defining the Economic Burden of Perioperative Venous Thromboembolism in Inflammatory Bowel Disease in the United States

Dis Colon Rectum. 2021 Jul 1;64(7):871-880. doi: 10.1097/DCR.0000000000001942.

Chun Hin Angus Lee 1, Xuefei Jia 2, Jeremy M Lipman 1, Amy L Lightner 1, Tracy L Hull 1, Scott R Steele 1, Stefan D Holubar 1


Author information

  • 1Department of Colon & Rectal Surgery, Cleveland Clinic, Cleveland, Ohio.
  • 2Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.


Background: Patients with IBD are at increased risk of venous thromboembolism.

Objective: This study aims to define the economic burden associated with inpatient venous thromboembolism after surgery for IBD that presently remains undefined.

Design: This study is a retrospective, cross-sectional analysis using the National Inpatient Sample from 2004 to 2014.

Setting: Participating hospitals across the United States were sampled.

Patients: The International Classification of Diseases, 9th Revision codes were used to identify patients with a primary diagnosis of IBD.

Interventions: Major abdominopelvic bowel surgery was performed.

Main outcome measures: The primary outcome measured was the occurrence of inpatient venous thromboembolism. Univariate and multivariable patient- and hospital-level logistic regression models were used to compare patient characteristics, hospital characteristics, and outcomes between venous thromboembolism and non-venous thromboembolism cohorts. Total average direct costs were then compared between cohorts, and the resulting difference was extrapolated to the national population.

Results: Of 26,080 patients included, inpatient venous thromboembolism was identified in 581 (2.2%). On multivariable analysis, diagnosis of ulcerative colitis, transfer status, length of preoperative hospitalization, and insurance status were independently associated with inpatient venous thromboembolism. Patients with venous thromboembolism were observed to be associated with an increased median length of stay (17.6 vs 6.7 days; p < 0.001) and higher inpatient mortality (5.0% vs 1.1%; OR 4.7, SE 3.2-7.0; p < 0.001). After adjusting for clinically relevant covariates, the additional cost associated with each inpatient venous thromboembolism was $31,551 (95% CI, $29,136-$33,965).

Limitations: Our study is limited by the administrative nature of the National Inpatient Sample database, which limits our ability to evaluate the impact of clinical covariates (eg, use of venous thromboembolism chemoprophylaxis, steroid use, and nutrition status).

Conclusion: Inpatient venous thromboembolism in abdominopelvic surgery for IBD is an infrequent, yet costly, morbid complication. Given the magnitude of patient morbidity and economic burden, venous thromboembolism prevention should be a national quality improvement and research priority. See Video Abstract at http://links.lww.com/DCR/B544.

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