Complications and 30-day Outcomes Associated With Venous Thromboembolism in the Pediatric Orthopaedic Surgical Population.

Academic Article

Abstract

  • INTRODUCTION: The risk of morbidity associated with venous thromboembolism (VTE) after pediatric orthopaedic surgery remains unclear despite increased use of thromboprophylaxis measures. METHODS: The American College of Surgeons National Surgical Quality Improvement Program, Pediatric database was queried for patients undergoing an orthopaedic surgical procedure between 2012 and 2013. Upper extremity and skin/subcutaneous surgeries were excluded. Associations between VTE and procedure, demographics, comorbidities, preoperative laboratory values, and 30-day postoperative outcomes were evaluated. RESULTS: Of 14,776 cases, 15 patients (0.10%) experienced postoperative VTE. Deep vein thrombosis (DVT) occurred in 13 patients (0.09%), and pulmonary embolism developed in 2 patients (0.01%). The procedure with the highest VTE rate was surgery for infection (1.2%). Patient factors associated with the development of VTE included hyponatremia (P = 0.003), abnormal partial thromboplastin time (P = 0.046), elevated aspartate transaminase level (P = 0.004), and gastrointestinal (P = 0.011), renal (P = 0.016), and hematologic (P = 0.019) disorders. Nearly half (46.2%) of DVTs occurred postdischarge. Complications associated with VTE included prolonged hospitalization (P < 0.001), pneumonia (P < 0.001), unplanned intubation (P = 0.003), urinary tract infection (P = 0.003), and central line-associated bloodstream infection (P < 0.001). Most of the postoperative complications (66.7%) occurred before VTE diagnosis, and no patients with VTE died. CONCLUSION: In the absence of specified risk factors, thromboprophylaxis may be unnecessary for this population.
  • Keywords

  • Adolescent, Anticoagulants, Child, Comorbidity, Databases as Topic, Female, Humans, Incidence, Male, Orthopedic Procedures, Prognosis, Pulmonary Embolism, Risk Factors, United States, Venous Thromboembolism
  • Digital Object Identifier (doi)

    Author List

  • Baker D; Sherrod B; McGwin G; Ponce B; Gilbert S
  • Start Page

  • 196
  • End Page

  • 206
  • Volume

  • 24
  • Issue

  • 3