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Published on: August 13, 2017
No Association of Sirolimus with Wound Complications in Children With Vascular Anomalies
Steven C Mehl1, Richard S Whitlock1, Rachel M Ortega1
1Department of Surgery, Baylor College of Medicine, Houston, TX, USA; Department of Surgery, Division of Pediatric Surgery, Texas Children's Hospital, Houston, TX, USA.
Insights
Sirolimus (rapamycin) is effective for vascular anomalies but may delay wound healing. This study found no significant increase in surgical complications for pediatric patients receiving sirolimus perioperatively.
Area of Science:
- Pediatric Surgery
- Vascular Anomalies
- Pharmacology
Background:
- Sirolimus (rapamycin) is a key treatment for vascular anomalies.
- A known side effect is delayed surgical wound healing.
- The impact on perioperative complications in pediatric patients is unclear.
Purpose of the Study:
- To evaluate the association between sirolimus use and postoperative complications.
- Focus on pediatric patients with vascular anomalies undergoing surgical resection.
- Assess wound healing and overall complication rates.
Main Methods:
- Retrospective cohort study (2015-2020) of pediatric patients with vascular anomalies.
- Collected data on demographics, anomaly type, surgical variables, and sirolimus dosing.
- Univariate analysis compared outcomes between patients with and without perioperative sirolimus.
Main Results:
- 57 procedures in 47 patients; 21 involved perioperative sirolimus.
- Comparable preoperative and postoperative sirolimus levels observed.
- Postoperative complication rates (19% vs. 11%) and wound complication rates (14% vs. 6%) were not significantly different between groups.
Conclusions:
- Perioperative sirolimus use did not significantly increase complication rates in pediatric vascular anomaly surgery.
- Findings suggest sirolimus can be safely administered.
- Further research may explore optimal dosing and monitoring strategies.
Introduction:
Sirolimus has demonstrated effectiveness as a treatment option for several types of vascular anomalies; however, it has a potential side effect of delayed surgical wound healing. The purpose of this study was to evaluate the association of sirolimus with postoperative complications in the pediatric vascular anomaly population.
Methods:
A retrospective cohort study was performed for children with a vascular anomaly who underwent excision or debulking of the anomaly from 2015 to 2020. Patient demographics, vascular anomaly characteristics, operative variables, sirolimus dosing information, and perioperative outcomes were collected. Univariate analysis was performed to compare outcomes based on the administration of sirolimus.
Results:
Forty-seven patients with vascular anomalies underwent 57 surgical procedures (36 without perioperative sirolimus, 21 with perioperative sirolimus). The median age at the time of surgery was seven years (IQR 1.7-14.0). The most common anomalies were lymphatic and venolymphatic malformations. Of the patients administered perioperative sirolimus, the median preoperative and postoperative sirolimus levels were comparable (preoperative 6.9 ng/mL (IQR 4.9-10.1), postoperative 6.5 ng/mL (IQR 4.7-9.4)). The rate of postoperative complications (sirolimus 19%, without sirolimus 11%; p = 0.45) and wound complications (sirolimus 14%, without sirolimus 6%; p = 0.26) were comparable between the cohorts.
Conclusion:
Our results suggest sirolimus may not significantly increase perioperative complication rates in pediatric patients undergoing resection of their vascular anomaly.
Level Of Evidence:
Level III.
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