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

Elizabeth T. Stephens; Anh Thy H. Nguyen; Julie Jaffray; Brian Branchford; Ernest K. Amankwah; Neil A. Goldenberg; E. Vincent S. Faustino; Neil A. Zakai; Amy Stillings; Emily Krava; Guy Young; John H. Fargo

doi:10.1002/rth2.12810

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

Elizabeth T. Stephens^*, Anh Thy H. Nguyen, Julie Jaffray, Brian Branchford, Ernest K. Amankwah, Neil A. Goldenberg, E. Vincent S. Faustino, Neil A. Zakai, Amy Stillings, Emily Krava, Guy Young, John H. Fargo

^*Corresponding author for this work

Pediatrics

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Surgery is a known risk factor for hospital-acquired venous thromboembolism (HA-VTE) in children. Objectives: To assess whether the odds of HA-VTE differs across six anatomic sites of noncardiac surgery and to identify risk factors for HA-VTE in these children. Methods: This was a multicenter, case–control study. Anatomic sites of surgery and risk factors for HA-VTE were collected on hospitalized pediatric patients who had undergone a single noncardiac surgery and developed HA-VTE (cases), and those who did not develop HA-VTE (controls), via the Children's Hospital-Acquired Thrombosis (CHAT) Registry. Logistic regression estimated the odds ratio (OR) and 95% confidence intervals (CIs) between six anatomic sites of surgery and 16 putative HA-VTE risk factors. Variables with a p value of 0.10 or less in unadjusted analyses were included in adjusted models for further evaluation. The final model used backward selection, with a significance level of 0.05. Results: From January 2012 to March 2020, 163 cases (median age, 5.7 years; interquartile range [IQR], 0.3–14.2) and 208 controls (median age of 7.5 years; IQR, 3.7–12.9) met our criteria. There was no statistically significant increased odds of VTE among the types of noncardiac surgery. In the final adjusted model, central venous catheter (CVC; OR, 14.69; 95% CI, 7.06–30.55), intensive care unit (ICU) stay (OR, 5.31; 95% CI, 2.53–11.16), and hospitalization in the month preceding surgery (OR, 2.75; 95% CI, 1.24–6.13) were each independently significant risk factors for HA-VTE. Conclusion: In children undergoing noncardiac surgery, placement of CVCs, admission/transfer to the ICU, or hospitalization in the month prior to surgery were positively associated with HA-VTE.

Original language	English (US)
Article number	e12810
Journal	Research and Practice in Thrombosis and Haemostasis
Volume	6
Issue number	7
DOIs	https://doi.org/10.1002/rth2.12810
State	Published - Oct 2022

Funding

E. Amankwah is a consultant for the Data Safety Monitoring Board for Pfizer and Bristol Myers Squibb. E. V. S. Faustino receives grant funding from the National Institutes of Health, American Heart Association, and Grifols Shared Services of North America; and receives an honorarium as medical advisory board member for Boehringer‐Ingelheim. There are no other conflicts of interest disclosed for the authors E. Stephens, A. H. Nguyen, J. Jaffray, B. Branchford, E. Amankwah, N. A. Goldenberg, N. A. Zakai, A. Stillings, E. Krava, G. Young, and J. H. Fargo. The authors would like to recognize the efforts of the clinical research coordinators at the CHAT Consortium sites that contributed to this study. This work was supported by the National Institutes of Health from the National Center for Advancing Translational Science (grant #UL1TR001855) to Julie Jaffray, and the Children's Hospital Saban Research mentored career development award to Julie Jaffray. Funding sources did not have a role in study design, data analysis, writing, or submission of the manuscript.

Keywords

Hospitals
Pediatric
Surgery
Thrombosis
Venous thromboembolism

ASJC Scopus subject areas

Hematology

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10.1002/rth2.12810

Cite this

Stephens, E. T., Nguyen, A. T. H., Jaffray, J., Branchford, B., Amankwah, E. K., Goldenberg, N. A., Faustino, E. V. S., Zakai, N. A., Stillings, A., Krava, E., Young, G., & Fargo, J. H. (2022). Risk of venous thromboembolism in pediatric hospitalized patients undergoing noncardiac surgery: A report from the Children's Hospital-Acquired Thrombosis consortium. Research and Practice in Thrombosis and Haemostasis, 6(7), Article e12810. https://doi.org/10.1002/rth2.12810

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title = "Risk of venous thromboembolism in pediatric hospitalized patients undergoing noncardiac surgery: A report from the Children's Hospital-Acquired Thrombosis consortium",

abstract = "Background: Surgery is a known risk factor for hospital-acquired venous thromboembolism (HA-VTE) in children. Objectives: To assess whether the odds of HA-VTE differs across six anatomic sites of noncardiac surgery and to identify risk factors for HA-VTE in these children. Methods: This was a multicenter, case–control study. Anatomic sites of surgery and risk factors for HA-VTE were collected on hospitalized pediatric patients who had undergone a single noncardiac surgery and developed HA-VTE (cases), and those who did not develop HA-VTE (controls), via the Children's Hospital-Acquired Thrombosis (CHAT) Registry. Logistic regression estimated the odds ratio (OR) and 95% confidence intervals (CIs) between six anatomic sites of surgery and 16 putative HA-VTE risk factors. Variables with a p value of 0.10 or less in unadjusted analyses were included in adjusted models for further evaluation. The final model used backward selection, with a significance level of 0.05. Results: From January 2012 to March 2020, 163 cases (median age, 5.7 years; interquartile range [IQR], 0.3–14.2) and 208 controls (median age of 7.5 years; IQR, 3.7–12.9) met our criteria. There was no statistically significant increased odds of VTE among the types of noncardiac surgery. In the final adjusted model, central venous catheter (CVC; OR, 14.69; 95% CI, 7.06–30.55), intensive care unit (ICU) stay (OR, 5.31; 95% CI, 2.53–11.16), and hospitalization in the month preceding surgery (OR, 2.75; 95% CI, 1.24–6.13) were each independently significant risk factors for HA-VTE. Conclusion: In children undergoing noncardiac surgery, placement of CVCs, admission/transfer to the ICU, or hospitalization in the month prior to surgery were positively associated with HA-VTE.",

keywords = "Hospitals, Pediatric, Surgery, Thrombosis, Venous thromboembolism",

author = "Stephens, {Elizabeth T.} and Nguyen, {Anh Thy H.} and Julie Jaffray and Brian Branchford and Amankwah, {Ernest K.} and Goldenberg, {Neil A.} and Faustino, {E. Vincent S.} and Zakai, {Neil A.} and Amy Stillings and Emily Krava and Guy Young and Fargo, {John H.}",

note = "Publisher Copyright: {\textcopyright} 2022 The Authors. Research and Practice in Thrombosis and Haemostasis published by Wiley Periodicals LLC on behalf of International Society on Thrombosis and Haemostasis (ISTH).",

year = "2022",

month = oct,

doi = "10.1002/rth2.12810",

language = "English (US)",

volume = "6",

journal = "Research and Practice in Thrombosis and Haemostasis",

issn = "2475-0379",

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number = "7",

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Stephens, ET, Nguyen, ATH, Jaffray, J, Branchford, B, Amankwah, EK, Goldenberg, NA, Faustino, EVS, Zakai, NA, Stillings, A, Krava, E, Young, G & Fargo, JH 2022, 'Risk of venous thromboembolism in pediatric hospitalized patients undergoing noncardiac surgery: A report from the Children's Hospital-Acquired Thrombosis consortium', Research and Practice in Thrombosis and Haemostasis, vol. 6, no. 7, e12810. https://doi.org/10.1002/rth2.12810

Risk of venous thromboembolism in pediatric hospitalized patients undergoing noncardiac surgery: A report from the Children's Hospital-Acquired Thrombosis consortium. / Stephens, Elizabeth T.; Nguyen, Anh Thy H.; Jaffray, Julie et al.
In: Research and Practice in Thrombosis and Haemostasis, Vol. 6, No. 7, e12810, 10.2022.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Risk of venous thromboembolism in pediatric hospitalized patients undergoing noncardiac surgery

T2 - A report from the Children's Hospital-Acquired Thrombosis consortium

AU - Stephens, Elizabeth T.

AU - Nguyen, Anh Thy H.

AU - Jaffray, Julie

AU - Branchford, Brian

AU - Amankwah, Ernest K.

AU - Goldenberg, Neil A.

AU - Faustino, E. Vincent S.

AU - Zakai, Neil A.

AU - Stillings, Amy

AU - Krava, Emily

AU - Young, Guy

AU - Fargo, John H.

N1 - Publisher Copyright: © 2022 The Authors. Research and Practice in Thrombosis and Haemostasis published by Wiley Periodicals LLC on behalf of International Society on Thrombosis and Haemostasis (ISTH).

PY - 2022/10

Y1 - 2022/10

N2 - Background: Surgery is a known risk factor for hospital-acquired venous thromboembolism (HA-VTE) in children. Objectives: To assess whether the odds of HA-VTE differs across six anatomic sites of noncardiac surgery and to identify risk factors for HA-VTE in these children. Methods: This was a multicenter, case–control study. Anatomic sites of surgery and risk factors for HA-VTE were collected on hospitalized pediatric patients who had undergone a single noncardiac surgery and developed HA-VTE (cases), and those who did not develop HA-VTE (controls), via the Children's Hospital-Acquired Thrombosis (CHAT) Registry. Logistic regression estimated the odds ratio (OR) and 95% confidence intervals (CIs) between six anatomic sites of surgery and 16 putative HA-VTE risk factors. Variables with a p value of 0.10 or less in unadjusted analyses were included in adjusted models for further evaluation. The final model used backward selection, with a significance level of 0.05. Results: From January 2012 to March 2020, 163 cases (median age, 5.7 years; interquartile range [IQR], 0.3–14.2) and 208 controls (median age of 7.5 years; IQR, 3.7–12.9) met our criteria. There was no statistically significant increased odds of VTE among the types of noncardiac surgery. In the final adjusted model, central venous catheter (CVC; OR, 14.69; 95% CI, 7.06–30.55), intensive care unit (ICU) stay (OR, 5.31; 95% CI, 2.53–11.16), and hospitalization in the month preceding surgery (OR, 2.75; 95% CI, 1.24–6.13) were each independently significant risk factors for HA-VTE. Conclusion: In children undergoing noncardiac surgery, placement of CVCs, admission/transfer to the ICU, or hospitalization in the month prior to surgery were positively associated with HA-VTE.

AB - Background: Surgery is a known risk factor for hospital-acquired venous thromboembolism (HA-VTE) in children. Objectives: To assess whether the odds of HA-VTE differs across six anatomic sites of noncardiac surgery and to identify risk factors for HA-VTE in these children. Methods: This was a multicenter, case–control study. Anatomic sites of surgery and risk factors for HA-VTE were collected on hospitalized pediatric patients who had undergone a single noncardiac surgery and developed HA-VTE (cases), and those who did not develop HA-VTE (controls), via the Children's Hospital-Acquired Thrombosis (CHAT) Registry. Logistic regression estimated the odds ratio (OR) and 95% confidence intervals (CIs) between six anatomic sites of surgery and 16 putative HA-VTE risk factors. Variables with a p value of 0.10 or less in unadjusted analyses were included in adjusted models for further evaluation. The final model used backward selection, with a significance level of 0.05. Results: From January 2012 to March 2020, 163 cases (median age, 5.7 years; interquartile range [IQR], 0.3–14.2) and 208 controls (median age of 7.5 years; IQR, 3.7–12.9) met our criteria. There was no statistically significant increased odds of VTE among the types of noncardiac surgery. In the final adjusted model, central venous catheter (CVC; OR, 14.69; 95% CI, 7.06–30.55), intensive care unit (ICU) stay (OR, 5.31; 95% CI, 2.53–11.16), and hospitalization in the month preceding surgery (OR, 2.75; 95% CI, 1.24–6.13) were each independently significant risk factors for HA-VTE. Conclusion: In children undergoing noncardiac surgery, placement of CVCs, admission/transfer to the ICU, or hospitalization in the month prior to surgery were positively associated with HA-VTE.

KW - Hospitals

KW - Pediatric

KW - Surgery

KW - Thrombosis

KW - Venous thromboembolism

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DO - 10.1002/rth2.12810

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AN - SCOPUS:85141974381

SN - 2475-0379

VL - 6

JO - Research and Practice in Thrombosis and Haemostasis

JF - Research and Practice in Thrombosis and Haemostasis

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M1 - e12810

ER -

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

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