Venous thromboembolism following inpatient pediatric surgery: Analysis of 153,220 patients

Academic Article

Abstract

  • © 2018 Elsevier Inc. Purpose: To evaluate venous thromboembolism (VTE) rates and risk factors following inpatient pediatric surgery. Methods: 153,220 inpatient pediatric surgical patients were selected from the 2012–2015 NSQIP-P database. Demographic and perioperative variables were documented. Primary outcome was VTE requiring treatment within 30 postoperative days. Secondary outcomes included length of stay (LOS) and 30-day mortality. Prediction models were generated using logistic regression. Mortality and time to VTE were assessed using Kaplan–Meier survival analysis. Results: 305 patients (0.20%) developed 296 venous thromboses and 12 pulmonary emboli (3 cooccurrences). Median time to VTE was 9 days. Most VTEs (81%) occurred predischarge. Subspecialties with highest VTE rates were cardiothoracic (0.72%) and general surgery (0.28%). No differences were seen for elective vs. urgent/emergent procedures (p = 0.106). All-cause mortality VTE patients was 1.2% vs. 0.2% in patients without VTE (p < 0.001). After stratifying by American Society of Anesthesiologists (ASA) class, no mortality differences remained when ASA < 3. Preoperative, postoperative, and total LOSs were longer for patients with VTE (p < 0.001 for each). ASA ≥ 3, preoperative sepsis, ventilator dependence, enteral/parenteral feeding, steroid use, preoperative blood transfusion, gastrointestinal disease, hematologic disorders, operative time, and age were independent predictors (C-statistic = 0.83). Conclusions: Pediatric postsurgical patients have unique risk factors for developing VTE. Level of evidence: Level II.
  • Digital Object Identifier (doi)

    Author List

  • Sherrod BA; McClugage SG; Mortellaro VE; Aban IB; Rocque BG
  • Start Page

  • 631
  • End Page

  • 639
  • Volume

  • 54
  • Issue

  • 4