High Rates of Pediatric Venous Thromboembolism After Elective Laparoscopic Splenectomy Suggest Need for Perioperative
Ryan Bram1, Jason Bram2, Amanda Beaman3
1Tripler Army Medical Center, Honolulu Hawaii.
Insights
Pediatric patients undergoing elective laparoscopic splenectomy have a higher risk of venous thromboembolism (VTE) compared to other laparoscopic procedures. This suggests a need for further research into prophylactic treatments for VTE in this population.
Area of Science:
- Pediatric Surgery
- Thrombosis Research
- Surgical Outcomes
Background:
- Postoperative venous thromboembolism (VTE) affects up to 8% of adult laparoscopic splenectomy (LS) cases.
- VTE is rare in pediatric surgical patients (<1%).
- Elective LS in children may pose a higher VTE risk than other laparoscopic procedures.
Purpose of the Study:
- To investigate the hypothesis that pediatric patients have an elevated risk of postoperative VTE after elective LS.
- To compare VTE incidence in pediatric elective LS patients to other laparoscopic procedures.
- To inform potential prophylactic treatment strategies for VTE in pediatric elective LS.
Main Methods:
- Utilized the American College of Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database (2012-2020).
- Identified patients undergoing elective LS using Current Procedural Terminology code 38120.
- Analyzed VTE incidence across different pediatric surgical groups.
Main Results:
- Overall pediatric surgical VTE incidence was 0.13%.
- Elective laparoscopic abdominopelvic procedure VTE incidence was 0.17%.
- Elective LS showed a VTE incidence of 0.41% (seven cases), more than double the general pediatric rate (P=0.001).
- Eighty percent of pediatric LS patients had an underlying hematological disorder.
Conclusions:
- This study analyzed the largest cohort of pediatric elective LS patients to date.
- Pediatric elective LS is associated with a significantly higher VTE incidence compared to general pediatric surgery and other laparoscopic abdominopelvic procedures.
- Underlying hematological conditions likely contribute to the increased VTE risk.
- Further research is warranted to evaluate the efficacy of perioperative VTE prophylaxis in pediatric patients undergoing elective LS.
Introduction:
In adult populations, postoperative venous thromboembolism (VTE) is a reported complication of up to 8% of elective laparoscopic splenectomy (LS) cases. VTE is a rare event in the pediatric population, affecting less than 1% of all pediatric surgical patients. We hypothesized that pediatric patients are at a higher risk of postoperative VTE after undergoing elective LS relative to other laparoscopic procedures and may warrant prophylactic treatment.
Materials And Methods:
We queried the American College of Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database from 2012 to 2020. Patients were identified using the Current Procedural Terminology code 38120 and only elective cases were analyzed.
Results:
The incidence of VTE in all pediatric patients undergoing surgery in the American College of Surgeons NSQIP-P database was 0.13%. The incidence of VTE in pediatric patients undergoing elective laparoscopic abdominopelvic procedures was 0.17%. There were seven total cases of VTE (0.41%) in pediatric patients undergoing elective LS, more than twice the rate of the general population (P = 0.001). Eighty percent of pediatric patients undergoing elective LS had an underlying hematological disorder.
Conclusions:
By analyzing the NSQIP-P database, we evaluated the largest cohort of pediatric patients undergoing elective LS to date. We identified a higher incidence of VTE following this procedure relative to the rate of VTE in the overall population in the NSQIP-P database, as well as those undergoing elective laparoscopic abdominopelvic operations. The relatively higher incidence of VTE after elective LS is likely due to the presence of underlying hematological conditions. Given the low incidence of complications associated with pharmacologic VTE prophylaxis, the results of this study suggest that further research is warranted to establish the efficacy of perioperative pharmacological VTE prophylaxis in pediatric patients undergoing elective LS.
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