Sarah B Cairo1, Timothy B Lautz2, Beverly A Schaefer3, Guan Yu4, Hibbut-Ur-Rauf Naseem5, David H Rothstein6. 1. Department of Pediatric Surgery, John R Oshei Children's Hospital, 1001 Main Street, Buffalo, NY 14202. Electronic address: scairo2@gmail.com. 2. Department of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611. 3. Department of Pediatric Hematology and Oncology, John R Oshei Children's Hospital, 1001 Main Street, Buffalo, NY 14202; Department of Pediatrics, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263; Department of Pediatrics, State University of New York, University at Buffalo, 3435 Main Street, Buffalo, NY 14214. 4. Department of Biostatistics, State University of New York, University at Buffalo, 3435 Main Street, Buffalo, NY 14214. 5. Department of Pediatric Surgery, John R Oshei Children's Hospital, 1001 Main Street, Buffalo, NY 14202. 6. Department of Pediatric Surgery, John R Oshei Children's Hospital, 1001 Main Street, Buffalo, NY 14202; Department of Surgery, State University of New York, University at Buffalo, 3435 Main Street, Buffalo, NY 14214.
Abstract
BACKGROUND: Venous thromboembolism (VTE) in pediatric surgical patients is a rare event. The risk factors for VTE in pediatric general surgery patients undergoing abdominopelvic procedures are unknown. STUDY DESIGN: The American College of Surgeon's National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database (2012-2015) was queried for patients with VTE after abdominopelvic general surgery procedures. Patient and operative variables were assessed to identify risk factors associated with VTE and develop a pediatric risk score. RESULTS: From 2012-2015, 68 of 34,813 (0.20%) patients who underwent abdominopelvic general surgery procedures were diagnosed with VTE. On multivariate analysis, there was no increased risk of VTE based on concomitant malignancy, chemotherapy, inflammatory bowel disease, or laparoscopic surgical approach, while a higher rate of VTE was identified among female patients. The odds of experiencing VTE were increased on stepwise regression for patients older than 15 years and those with preexisting renal failure or a diagnosis of septic shock, patients with American Society of Anesthesia (ASA) classification ≥ 2, and for anesthesia time longer than 2 h. The combination of age > 15 years, ASA classification ≥ 2, anesthesia time > 2 h, renal failure, and septic shock was included in a model for predicting risk of VTE (AUC = 0.907, sensitivity 84.4%, specificity 88.2%). CONCLUSION: VTE is rare in pediatric patients, but prediction modeling may help identify those patients at heightened risk. Additional studies are needed to validate the factors identified in this study in a risk assessment model as well as to assess the efficacy and cost-effectiveness of prophylaxis methods. LEVEL OF EVIDENCE: Level III, retrospective comparative study.
BACKGROUND:Venous thromboembolism (VTE) in pediatric surgical patients is a rare event. The risk factors for VTE in pediatric general surgery patients undergoing abdominopelvic procedures are unknown. STUDY DESIGN: The American College of Surgeon's National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database (2012-2015) was queried for patients with VTE after abdominopelvic general surgery procedures. Patient and operative variables were assessed to identify risk factors associated with VTE and develop a pediatric risk score. RESULTS: From 2012-2015, 68 of 34,813 (0.20%) patients who underwent abdominopelvic general surgery procedures were diagnosed with VTE. On multivariate analysis, there was no increased risk of VTE based on concomitant malignancy, chemotherapy, inflammatory bowel disease, or laparoscopic surgical approach, while a higher rate of VTE was identified among female patients. The odds of experiencing VTE were increased on stepwise regression for patients older than 15 years and those with preexisting renal failure or a diagnosis of septic shock, patients with American Society of Anesthesia (ASA) classification ≥ 2, and for anesthesia time longer than 2 h. The combination of age > 15 years, ASA classification ≥ 2, anesthesia time > 2 h, renal failure, and septic shock was included in a model for predicting risk of VTE (AUC = 0.907, sensitivity 84.4%, specificity 88.2%). CONCLUSION:VTE is rare in pediatric patients, but prediction modeling may help identify those patients at heightened risk. Additional studies are needed to validate the factors identified in this study in a risk assessment model as well as to assess the efficacy and cost-effectiveness of prophylaxis methods. LEVEL OF EVIDENCE: Level III, retrospective comparative study.
Authors: Shannon C Walker; C Buddy Creech; Henry J Domenico; Benjamin French; Daniel W Byrne; Allison P Wheeler Journal: Pediatrics Date: 2021-05-19 Impact factor: 9.703
Authors: Kyle O Rove; Andrew C Strine; Duncan T Wilcox; Gino J Vricella; Timothy P Welch; Brian VanderBrink; David I Chu; Rajeev Chaudhry; Rebecca S Zee; Megan A Brockel Journal: BMJ Open Date: 2020-11-23 Impact factor: 2.692
Authors: Elizabeth T Stephens; Anh Thy H Nguyen; Julie Jaffray; Brian Branchford; Ernest K Amankwah; Neil A Goldenberg; E Vincent S Faustino; Neil A Zakai; Amy Stillings; Emily Krava; Guy Young; John H Fargo Journal: Res Pract Thromb Haemost Date: 2022-10-13