Venous thromboembolism in children undergoing surgery: incidence, risk factors and related adverse events

Abstract

BackgroundAlthough less common in adults, venous thromboembolism (VTE) in children is a highly morbid, preventable adverse event. While VTE has been well studied among pediatric hospitalized and trauma patients, limited work has been done to examine postoperative VTE in children undergoing surgery.MethodsUsing data from National Surgical Quality Improvement Project Pediatric database (NSQIP-P) from 2012 to 2016, a retrospective cohort analysis was performed to determine the incidence of, and risk factors for, VTE in children undergoing surgery. Additionally, the relationships between VTE and other postoperative adverse outcomes were evaluated.ResultsOf 361 384 pediatric surgical patients, 378 (0.10%) were identified as experiencing postoperative VTE. After controlling for patient and surgical factors, we found that American Society of Anesthesiologists (ASA) class of II or greater, aged 16–18 years, non-elective surgery, general surgery (compared with several other surgical specialties), cardiothoracic surgery (compared with general surgery) and longer operative time were significantly associated with VTE in pediatric patients (p<0.001 for each comparison). Furthermore, a majority of adverse events were found to be associated with increased risk of subsequent VTE (p<0.001).ConclusionIn a large pediatric surgical population, an incidence of postoperative VTE of 0.10% was observed. Defined patient and surgical factors, and perioperative adverse events were found to be associated with such VTE events.

Risk of venous thromboembolism in pediatric hospitalized patients undergoing noncardiac surgery: A report from the Children's Hospital‐Acquired Thrombosis consortium

“…There is a lack of previous studies of pediatric surgery‐associated VTE specifically evaluating ICU admission as a risk factor. However, previous studies did evaluate clinical acuity and markers of illness severity in other ways including ASA score, preoperative blood transfusions, preoperative ventilation, intubation, septic shock, and sepsis and found an association with increased risk of VTE 11,12,28‐30 . Ahn et al 12 and Sherrod et al 29 both found preoperative ventilator requirement was associated with the development of a VTE.…”

“…However, previous studies did evaluate clinical acuity and markers of illness severity in other ways including ASA score, preoperative blood transfusions, preoperative ventilation, intubation, septic shock, and sepsis and found an association with increased risk of VTE. 11 , 12 , 28 , 29 , 30 Ahn et al 12 and Sherrod et al 29 both found preoperative ventilator requirement was associated with the development of a VTE. Also Cairo et al 28 in 2018 and Sherrod et al 29 showed preoperative sepsis to be associated with the development of a postoperative VTE.…”

“…HA‐VTE remains a cause of morbidity and mortality in hospitalized pediatric surgical patients. 11 , 12 After multivariable adjustment, this multicenter case–control study of hospitalized pediatric participants undergoing noncardiac surgery identified CVC, ICU stay, and hospitalization within the prior month as independent risk factors for HA‐VTE.…”

“…Based on previous studies, this was not expected. From the American College of Surgeons' National Surgical Quality Improvement Project (NSQIP) Pediatric Registry, Mets et al 11 found cardiothoracic surgery, compared to general surgery, had increased odds of VTE with an OR of 3.2, but did not find an increased risk of VTE with six other surgical specialties. Sherrod et al 29 also used data from the NSQIP Pediatric Registry to demonstrate that cardiothoracic surgery had the highest HA‐VTE rate, followed by general surgery, ENT, and neurosurgery.…”

“… 10 Risk factors that have been associated with pediatric surgical VTE include an American Society of Anesthesiologists (ASA) classification greater than 2, nonelective surgery, operation time greater than 2 h, age greater than 15 years, adverse events surrounding surgery, and cardiothoracic surgery. 11 , 12 In addition, other factors besides surgery, including presence of a central venous catheter (CVC), intensive care unit (ICU) admission or stay, prolonged hospital length of stay, immobility, and thrombophilia have been associated with VTE in children. 1 , 9 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 Less is known about their effect on postoperative hospital‐acquired VTE (HA‐VTE) risk.…”