Risk factors for venous thromboembolic events in pediatric surgical patients: Defining indications for prophylaxis
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In brief
In brief
Retrospective analysis of 34,813 pediatric abdominopelvic surgery cases identifies VTE risk factors including age >15 years, ASA ≥2, prolonged anesthesia, renal failure, and septic shock. A predictive model combining these factors achieved 90.7% AUC for identifying high-risk patients who may benefit from prophylaxis.
Written by the GCMD Library team from the article.
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.