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Risk Factors for Venous Thromboembolism in Children Undergoing Orthopedic Surgery

Elbert J Mets, Neil Pathak, Anoop R Galivanche

    Orthopedics
    |November 30, 2021
    PubMed

    Insights

    Pediatric orthopedic surgery patients have a low incidence of venous thromboembolism (VTE) at 0.07%. Key risk factors include older age, higher ASA class, blood transfusions, specific surgeries, and adverse events, suggesting a need for targeted VTE prophylaxis.

    Area of Science:

    • Pediatric Orthopedic Surgery
    • Venous Thromboembolism (VTE)
    • Patient Safety

    Background:

    • Venous thromboembolism (VTE) is a rare but serious complication in children.
    • Identifying risk factors for VTE in pediatric orthopedic surgery is crucial for prevention.

    Purpose of the Study:

    • To determine the incidence of VTE in children undergoing orthopedic surgery.
    • To identify demographic, surgical, and perioperative risk factors for VTE in this population.

    Main Methods:

    • Retrospective analysis of the 2012-2017 American College of Surgeons National Surgical Quality Improvement Program Pediatric (NSQIP-P) database.
    • Comparison of patient demographics, comorbidities, operative variables, and outcomes between VTE and non-VTE groups.
    • Multivariate regression analysis to identify independent risk factors for VTE.

    Main Results:

    • A total of 81,490 pediatric patients were analyzed, with a VTE incidence of 0.07% (60 patients).
    • Independent risk factors for VTE included: older age (16-18 years), American Society of Anesthesiologists (ASA) classes III/V, preoperative blood transfusion, arthrotomy, and femur fracture.
    • Postoperative adverse events (any, major, minor), reoperation, and readmission were also significant independent risk factors for VTE.

    Conclusions:

    • The incidence of VTE in pediatric orthopedic surgery is low (0.07%).
    • Specific patient and surgical factors significantly increase VTE risk.
    • Findings support the need for VTE prophylaxis in select high-risk pediatric subpopulations undergoing orthopedic procedures.

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