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Thromboembolic complications in children after spinal fusion surgery
Amit Jain1, Dominique J Karas, Richard L Skolasky
1From the Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
Insights
The incidence of venous thromboembolic complications in children undergoing spinal fusion surgery is approximately 21 per 10,000 procedures. Older age and specific diagnoses like congenital scoliosis increase risk, while pulmonary embolism is rare and not fatal.
Area of Science:
- Pediatric Surgery
- Vascular Surgery
- Orthopedic Surgery
Background:
- The incidence of venous thromboembolic (VTE) complications, including pulmonary embolism (PE), following pediatric spinal fusion surgery is not well-established.
- Understanding these risks is crucial for optimizing patient care and surgical outcomes.
Purpose of the Study:
- To determine the incidence of VTE and PE in children undergoing spinal fusion.
- To report mortality associated with these complications.
- To identify factors contributing to the development of VTE in this patient population.
Main Methods:
- Retrospective review of the Nationwide Inpatient Sample database (2001-2010).
- Identification of pediatric patients (≤18 years) who underwent spinal fusion.
- Analysis using univariate and multivariate logistic regression models to assess risk factors.
Main Results:
- The overall incidence of VTE was approximately 21 events per 10,000 spinal fusions, with PE incidence at 2 events per 10,000.
- No in-hospital VTE-associated mortalities were recorded.
- Increased VTE risk was significantly associated with patient diagnosis (congenital scoliosis, syndromic scoliosis/kyphoscoliosis, thoracolumbar fractures) and older age.
Conclusions:
- Thromboembolic complications occur in approximately 2.1% of pediatric spinal fusion surgeries.
- Congenital scoliosis, syndromic spinal deformities, thoracolumbar fractures, and advanced age are significant risk factors for VTE.
- Pulmonary embolism is an infrequent complication in this cohort and does not appear to be associated with mortality.
Study Design:
Retrospective review.
Objective:
To identify the incidence of venous thromboembolic (VTE) complications and pulmonary embolism (PE) in children undergoing spinal fusion surgery, to report associated mortality, and to analyze factors associated with their development.
Summary Of Background Data:
The incidence of these complications after pediatric spinal fusion surgery is unknown.
Methods:
The Nationwide Inpatient Sample database was queried from 2001 through 2010 to identify children (≤18 yr) who had spinal fusion surgery. Patients who had deep venous thrombosis or PE during the hospital stay were identified using appropriate International Classification of Diseases, Ninth Revision, Clinical Modification codes. Univariate and multivariate logistic regression models were used for analysis; statistical significance was set at P less than 0.05.
Results:
Depending on the year, the incidence of VTE in children varied from 9.6 to 38.5 events per 10,000 spinal fusions (mean: 21 events per 10,000 spinal fusions), and the incidence of PE varied from 0 to 6 events per 10,000 spinal fusions (mean: 2 events per 10,000 spinal fusions); there were no in-hospital VTE-associated mortalities. On multivariate logistic regression analysis, only patient diagnosis was found to be significantly associated with VTE development. VTE incidence was significantly higher in children with congenital scoliosis, syndromic scoliosis/kyphoscoliosis, and thoracolumbar fractures than in children with idiopathic scoliosis (odds ratios: 4.21, 7.14, and 12.59, respectively). On univariate analysis, in addition to diagnosis, age was also found to be significantly associated with VTE development. For each year of age, the VTE incidence increased 1.37-fold (P < 0.01).
Conclusion:
The incidence of thromboembolic complications in children was approximately 21 events per 10,000 spinal fusions. A higher incidence of VTE in children was associated with older age and certain diagnoses (congenital scoliosis, syndromic scoliosis/kyphoscoliosis, and thoracolumbar fractures). PE in children was rare and not associated with fatality.
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