Faye AS¹, Wen T², Ananthakrishnan AN³, Lichtiger S⁴, Kaplan GG⁵, Friedman AM², Lawlor G⁴, Wright JD², Attenello FJ⁶, Mack WJ⁶, Lebwohl B⁷.

Author informationClin Gastroenterol Hepatol. 2019 Jul 20. pii: S1542-3565(19)30772-4. doi: 10.1016/j.cgh.2019.07.028. [Epub ahead of print]

Author information

1 Department of Medicine, Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, NY. Electronic address: asf2160@cumc.columbia.edu.

2 Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY.

3 Department of Medicine, Division of Gastroenterology, Massachusetts General Hospital, Boston, MA.

4 Department of Medicine, Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, NY.

5 Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.

6 Department of Neurologic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.

7 Department of Medicine, Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, NY. Electronic address: BL114@cumc.columbia.edu.

Abstract

BACKGROUND & AIMS: Patients with inflammatory bowel diseases (IBD) have a high risk of venous thromboembolism (VTE). We assess the timing and risk factors associated with readmission to the hospital for VTE among patients with IBD.

METHODS: We collected data from the Nationwide Readmissions Database on IBD index admissions resulting in readmission to the hospital for VTE within 60 days, from 2010 through 2014. We used univariable and multivariable regression to assess risk factors associated with VTE readmission with unadjusted (RR) and adjusted RR (aRR) as measures of effect. Time to VTE readmission was assessed in 10- day intervals up to 90 days.

RESULTS: We identified 872,122 index admissions of patients with IBD; 1160 resulted in readmission with VTE. More than 90% of readmissions occurred within 60 days of discharge from the index admission. Factors associated with hospital readmission with VTE included prior VTE, longer length of hospital stay, comorbidities, having a flexible sigmoidoscopy or colonoscopy at index admission, and age older than 18 years. Additional risk factors included Clostridium difficile infection at index admission (aRR, 1.47; 95% CI, 1.17-1.85) and discharge to a skilled nursing facility or intermediate care facility (aRR, 1.39; 95%CI 1.14-1.70) or discharge with home health services (aRR, 1.65; 95% CI, 1.41-1.94).

CONCLUSIONS: Among patients admitted to the hospital with IBD, most readmissions with VTE occur within 60 days of discharge. Readmission with VTE is associated C difficile infection and discharge to a skilled nursing facility, intermediate care facility, or with home health services. Studies are needed to evaluate the potential benefit of extending VTE prophylaxis for patients admitted to the hospital with IBD for up to 2 months after discharge, to minimize risk.