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Background: Guidelines recommend extended chemoprophylaxis for venous thromboembolism in high-risk patients having operations for inflammatory bowel disease. Quantifying patients' risk of venous thromboembolism, however, remains challenging. We sought (1) to identify factors associated with postdischarge venous thromboembolism in patients undergoing colorectal resection for inflammatory bowel disease and (2) to develop a postdischarge venous thromboembolism risk calculator to guide prescribing of extended chemoprophylaxis., Methods: Patients who underwent an operation for inflammatory bowel disease from 2012 to 2018 were identified from the American College of Surgeons National Surgical Quality Improvement Program for colectomy and proctectomy procedure targeted modules. Postdischarge venous thromboembolism included pulmonary embolism or deep vein thrombosis diagnosed after discharge from the index hospitalization. Multivariable logistic regression estimated the association of patient/operative factors with postdischarge venous thromboembolism. A postdischarge venous thromboembolism risk calculator was subsequently constructed., Results: Of 18,990 patients, 199 (1.1%) developed a postdischarge venous thromboembolism within the first 30 postoperative days. Preoperative factors associated with postdischarge venous thromboembolism included body mass index (1.9% with body mass index ≥35 vs 0.8% with body mass index 18.5-24.9; odds ratio 2.34 [95% confidence interval 1.49-3.67]), steroid use (1.3% vs 0.7%; odds ratio 1.91 [95% confidence interval 1.37-2.66]), and ulcerative colitis (1.5% vs 0.8% with Crohn's disease; odds ratio 1.76 [95% confidence interval 1.32-2.34]). Minimally invasive surgery was associated with postdischarge venous thromboembolism (1.2% vs 0.9% with open; odds ratio 1.42 [95% confidence interval 1.05-1.92]), as was anastomotic leak (2.8% vs 1.0%; odds ratio 2.24 [95% confidence interval 1.31-3.83]) and ileus (2.1% vs 0.9%; odds ratio 2.60 [95% confidence interval 1.91-3.54]). The predicted probability of postdischarge venous thromboembolism ranged from 0.2% to 14.3% based on individual risk factors., Conclusion: Preoperative, intraoperative, and postoperative factors are associated with postdischarge venous thromboembolism after an operation for inflammatory bowel disease. A postdischarge venous thromboembolism risk calculator was developed which can be used to tailor extended venous thromboembolism chemoprophylaxis by individual risk., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Purpose: Several methods have been used to measure quality of life (QOL) in colorectal patients, but existing QOL assessment tools are often complex, require complicated analysis, lack specificity for colorectal surgery, and are not focused on assessment of perioperative care. The postoperative QOL (PQL) assessment is designed to capture subtle yet important QOL factors in an easy tool validated for the postoperative period. Although internally validated, PQL lacks external validation with a universally accepted QOL metric, such as the Rand Short Form-36 (SF-36). The purpose of this study was to externally validate the PQL metric to the SF-36 for colorectal surgery., Methods: The PQL was designed using 14 questions ranked on a Likert scale (1-10) with surgeon and patient input. After obtaining institutional review board approval, 100 consecutive colorectal surgery patients at University Hospitals, Case Medical Center were administered baseline and postoperative (2, 4, 8, 12, 30, 60, and 90 days) PQL and SF-36 questionnaires prospectively. Patients undergoing colorectal surgery via an abdominal approach (laparoscopic or open) for benign or malignant disease were included. Factor analysis and Spearman's rank test were performed between each of the 8 SF-36 scales and the 14 PQL questions and summary score. Convergent validity was demonstrated using Spearman's correlation coefficient at the domain and scale levels. The degree of agreement between PQL and SF-36 was assessed through Bland-Altman plots. Pairwise comparisons were made to determine any significant differences between the 2 scales., Results: Eighty-eight patients met all inclusion criteria and had a complete dataset, and were included in the analysis. SF-36 factor analysis confirmed comparability between the study group and the general population. All PQL items correlated with all 8 mental and physical health domains in the SF-36 (P < .0001). Bland-Altman plots demonstrated consistently similar measure for level of agreement between PQL and SF-36 as indicated by the 95% limits of agreement., Conclusion: The PQL and SF-36 demonstrated a strong and consistent level of agreement across all 8 domains for pre- and postoperative scores in colorectal surgery patients. PQL is constructually valid in the perioperative period. Based on our analysis, the novel PQL metric represents a simple, point-of-care alternative to SF-36 for rapid QOL assessment, and validates use of the PQL metric in abdominal surgery., (Copyright © 2013 Mosby, Inc. All rights reserved.)

Background: Natural orifice translumenal endoscopic surgery (NOTES) allows access to the peritoneal cavity without skin incisions. Contamination of the peritoneal cavity by enteric contents may render NOTES more physiologically and immunologically invasive than previously thought. Measurement of interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha) is a validated method to quantify surgical stress. The physiologic and immunologic impact of NOTES is unknown., Methods: A total of 37 swine underwent abdominal exploration via transgastric NOTES peritoneoscopy, laparoscopy (LX), laparotomy (OPEN), or sham surgery (CONTROL) and were allowed to survive. TNF-alpha, IL-1beta, and IL-6 plasma levels were determined at the start and completion of surgery, and at 1 hour, 2 days, and 14 days postoperatively., Results: At surgical completion, OPEN animals demonstrated higher TNF-alpha levels than all groups. TNF-alpha levels were similar for all groups at 1 hour and 2 days. NOTES animals had significantly reduced plasma levels of TNF-alpha than all other groups on postoperative days 7 and 14. Controlling for baseline cytokine variability, analysis was repeated using normalized data, which confirmed significantly reduced TNF-alpha levels for NOTES compared with all groups at 14 days. Subset analysis excluding LX and OPEN complications revealed lower NOTES TNF-alpha levels at 7 and 14 days compared with all groups. IL-1beta and IL-6 levels were undetectable in 66.8% and 70.5% of samples, respectively, without significant trends., Conclusions: Diagnostic NOTES peritoneoscopy demonstrated similar levels of systemic proinflammatory cytokine TNF-alpha compared with diagnostic laparoscopy and exploratory laparotomy in the immediate postoperative period despite gross intraperitoneal contamination. None of the surgical groups, however, produced a measurable, consistent trend in IL-1beta or IL-6. Consistently reduced levels of TNF-alpha in NOTES animals in the late postoperative period indicates an immunomodulatory effect of the NOTES surgical technique not present in laparoscopy or laparotomy.