Risk factors for venous thromboembolic events in pediatric surgical patients: Defining indications for prophylaxis

Sarah B. Cairo*, Timothy B. Lautz, Beverly A. Schaefer, Guan Yu, Hibbut ur Rauf Naseem, David H. Rothstein

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Background: Venous thromboembolism (VTE) in pediatric surgical patients is a rare event. The risk factors for VTE in pediatric general surgery patients undergoing abdominopelvic procedures are unknown. Study design: The American College of Surgeon's National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database (2012–2015) was queried for patients with VTE after abdominopelvic general surgery procedures. Patient and operative variables were assessed to identify risk factors associated with VTE and develop a pediatric risk score. Results: From 2012-2015, 68 of 34,813 (0.20%) patients who underwent abdominopelvic general surgery procedures were diagnosed with VTE. On multivariate analysis, there was no increased risk of VTE based on concomitant malignancy, chemotherapy, inflammatory bowel disease, or laparoscopic surgical approach, while a higher rate of VTE was identified among female patients. The odds of experiencing VTE were increased on stepwise regression for patients older than 15 years and those with preexisting renal failure or a diagnosis of septic shock, patients with American Society of Anesthesia (ASA) classification ≥ 2, and for anesthesia time longer than 2 h. The combination of age > 15 years, ASA classification ≥ 2, anesthesia time > 2 h, renal failure, and septic shock was included in a model for predicting risk of VTE (AUC = 0.907, sensitivity 84.4%, specificity 88.2%). Conclusion: VTE is rare in pediatric patients, but prediction modeling may help identify those patients at heightened risk. Additional studies are needed to validate the factors identified in this study in a risk assessment model as well as to assess the efficacy and cost-effectiveness of prophylaxis methods. Level of Evidence: Level III, retrospective comparative study.

Original languageEnglish (US)
Pages (from-to)1996-2002
Number of pages7
JournalJournal of pediatric surgery
Volume53
Issue number10
DOIs
StatePublished - Oct 2018

Keywords

  • Abdominopelvic surgery
  • Deep vein thrombosis
  • Pediatric surgery
  • Pediatrics
  • Risk assessment
  • Venous thromboembolism

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Fingerprint Dive into the research topics of 'Risk factors for venous thromboembolic events in pediatric surgical patients: Defining indications for prophylaxis'. Together they form a unique fingerprint.

Cite this