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. 2016 Mar;24(3):196-206.
doi: 10.5435/JAAOS-D-15-00481.

Complications and 30-day Outcomes Associated With Venous Thromboembolism in the Pediatric Orthopaedic Surgical Population

Dustin Baker  1 , Brandon Sherrod, Gerald McGwin Jr, Brent Ponce, Shawn Gilbert
Affiliations

Complications and 30-day Outcomes Associated With Venous Thromboembolism in the Pediatric Orthopaedic Surgical Population

Dustin Baker et al. J Am Acad Orthop Surg. 2016 Mar.

Abstract

Introduction: The risk of morbidity associated with venous thromboembolism (VTE) after pediatric orthopaedic surgery remains unclear despite increased use of thromboprophylaxis measures.

Methods: The American College of Surgeons National Surgical Quality Improvement Program, Pediatric database was queried for patients undergoing an orthopaedic surgical procedure between 2012 and 2013. Upper extremity and skin/subcutaneous surgeries were excluded. Associations between VTE and procedure, demographics, comorbidities, preoperative laboratory values, and 30-day postoperative outcomes were evaluated.

Results: Of 14,776 cases, 15 patients (0.10%) experienced postoperative VTE. Deep vein thrombosis (DVT) occurred in 13 patients (0.09%), and pulmonary embolism developed in 2 patients (0.01%). The procedure with the highest VTE rate was surgery for infection (1.2%). Patient factors associated with the development of VTE included hyponatremia (P = 0.003), abnormal partial thromboplastin time (P = 0.046), elevated aspartate transaminase level (P = 0.004), and gastrointestinal (P = 0.011), renal (P = 0.016), and hematologic (P = 0.019) disorders. Nearly half (46.2%) of DVTs occurred postdischarge. Complications associated with VTE included prolonged hospitalization (P < 0.001), pneumonia (P < 0.001), unplanned intubation (P = 0.003), urinary tract infection (P = 0.003), and central line-associated bloodstream infection (P < 0.001). Most of the postoperative complications (66.7%) occurred before VTE diagnosis, and no patients with VTE died.

Conclusion: In the absence of specified risk factors, thromboprophylaxis may be unnecessary for this population.

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Figures

Figure 1
Figure 1
Case cohort selection from the National Surgical Quality Improvement Program (NSQIP) database by procedure type. LE = lower extremity, UE = upper extremity, VTE = venous thromboembolism
See this image and copyright information in PMC

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