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Incidence and risk factors associated with 30-day post-operative venous thromboembolism: A NSQIP-pediatric analysis
Jennifer J Ahn1, Paul A Merguerian1, Margarett Shnorhavorian1
1Division of Pediatric Urology, Seattle Children's Hospital, Seattle, WA, USA; Department of Urology, University of Washington, Seattle, WA, USA.
Insights
Pediatric venous thromboembolism (VTE) after surgery is rare but serious. Key risk factors include malignancy, pre-operative illness, and long anesthesia times, particularly in infants and adolescents.
Area of Science:
- Pediatric surgery
- Thromboembolism research
- Healthcare quality improvement
Background:
- Venous thromboembolism (VTE) is a rare but significant complication in children, with limited data on its incidence post-surgery.
- Existing research primarily focuses on pediatric trauma and critical care populations.
Purpose of the Study:
- To determine the incidence of VTE within 30 days following pediatric surgery.
- To identify risk factors associated with post-operative VTE in children.
Main Methods:
- Analysis of the National Surgical Quality Improvement Program Pediatric (NSQIPP) database (2012-2015).
- Inclusion of demographic, clinical, and peri-operative data for 267,299 surgical cases.
- Statistical analysis using descriptive statistics and multiple logistic regression.
Main Results:
- The 30-day incidence of post-operative VTE was 0.12% (12 per 10,000 cases).
- VTE incidence peaked in infants and adolescents.
- Malignancy, pre-operative illness, and prolonged anesthetic duration were linked to increased VTE risk.
Conclusions:
- Post-operative VTE incidence in the NSQIPP cohort mirrors rates in trauma and critical care populations.
- Identified risk factors (baseline illness, immobility, prolonged anesthesia) are consistent across pediatric VTE studies.
- The infrequent but significant occurrence of post-operative VTE necessitates guidelines for prophylaxis and treatment in at-risk children.
Intro:
Venous thromboembolism (VTE) is a rare event in children, but can cause significant morbidity and mortality. The majority of research on pediatric VTE has been in the trauma and critical care populations. The incidence of VTE after surgery in children is not well-established.
Objective:
The objective was to evaluate the incidence of VTE in the 30 days after surgery, as well as associated risk factors.
Study Design:
All cases in the National Surgical Quality Improvement Program Pediatric (NSQIPP) database from 2012 to 2015 were assessed for presence of post-operative VTE. Demographic, clinical, and peri-operative characteristics were collected. Descriptive statistics were performed, and multiple logistic regression models were created to estimate associated risk of VTE.
Results:
In a cohort of 267,299 surgical cases, the 30-day incidence of post-operative VTE was 12 per 10,000 cases (0.12%). VTE incidence followed a bi-modal distribution, highest in infants and adolescents (Figure). Malignancy, pre-operative illness, and greater anesthetic times were associated with increased risk of VTE.
Discussion:
The incidence of post-operative VTE in NSQIPP is similar to that seen in pediatric trauma and critical care populations. Risk factors are also consistent, including baseline illness, immobility, and prolonged anesthetic time.
Conclusion:
Post-operative VTE in children occurs infrequently, yet certain individuals are at increased risk and thus guidelines for prophylaxis and treatment are needed.
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