Risk of venous thromboembolism in children after general surgery

Humes, David J.; Nordenskjöld, Agneta; Walker, Alex J; West, Joe; Ludvigsson, Jonas F.

doi:10.1016/j.jpedsurg.2015.05.010

Cited by 17 publications

(12 citation statements)

References 21 publications

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“…The overall VTE rate is low and consistent with prior literature on pediatric VTE. [2,3,19,20] Several publications have reported VTE rates in the hospitalized pediatric population [2,3,[21][22][23] and in the intensive care population. [20,24,25] To date, no study has investigated the pediatric inpatient surgical population as a whole while comparing rates between procedures and subspecialties.…”

Section: Overall Vte Rates and Timing To Vtementioning

confidence: 99%

Venous thromboembolism following inpatient pediatric surgery: Analysis of 153,220 patients

Sherrod

McClugage

Mortellaro

et al. 2019

Journal of Pediatric Surgery

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Purpose: To evaluate venous thromboembolism (VTE) rates and risk factors following inpatient pediatric surgery.Methods: 153,220 inpatient pediatric surgical patients were selected from the 2012-2015 NSQIP-P database. Demographic and perioperative variables were documented. Primary outcome was VTE requiring treatment within 30 postoperative days. Secondary outcomes included length of stay (LOS) and 30-day mortality. Prediction models were generated using logistic regression. Mortality and time to VTE were assessed using Kaplan-Meier survival analysis.Results: 305 patients (0.20%) developed 296 venous thromboses and 12 pulmonary emboli (3 cooccurrences). Median time to VTE was 9 days. Most VTEs (81%) occurred pre-discharge. Subspecialties with highest VTE rates were cardiothoracic (0.72%) and general surgery (0.28%). No differences were seen for elective vs. urgent/emergent procedures (p=0.106). All-cause mortality VTE patients was 1.2% vs. 0.2% in patients without VTE (p<0.001). After stratifying by American Society of Anesthesiologists (ASA) class, no mortality differences remained when ASA < 3. Preoperative, postoperative, and total LOS were longer for patients with VTE (p<0.001 for each). ASA ≥ 3, preoperative sepsis, ventilator dependence, enteral/parenteral feeding, steroid use, preoperative blood transfusion, gastrointestinal disease, hematologic disorders, operative time, and age were independent predictors (C-statistic=0.83).Conclusions: Pediatric post-surgical patients have unique risk factors for developing VTE.

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Section: Overall Vte Rates and Timing To Vtementioning

confidence: 99%

Venous thromboembolism following inpatient pediatric surgery: Analysis of 153,220 patients

Sherrod

McClugage

Mortellaro

et al. 2019

Journal of Pediatric Surgery

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“…Follow up was until development of a VTE event, death, leaving a participating GP practice or 31 st Dec 2011, whichever was earliest. Those under the age of 18 years were excluded as we have reported the data previously [18].…”

Section: Cohort Identificationmentioning

confidence: 99%

Duration and Magnitude of Postoperative Risk of Venous Thromboembolism after Cholecystectomy: A Population-Based Cohort Study

Henry¹,

Abdul‐Sultan²,

Walker³

et al. 2019

Dig Surg

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Background: This study aimed to identify the burden and risk of venous thromboembolism (VTE) associated with cholecystectomy in England. Methods: An historical cohort study of cholecystectomy patients from 2001 to 2011 was undertaken using linked primary (Clinical Practice Research Datalink) and secondary (Hospital Episode Statistics) care data. Crude rates and adjusted hazard ratios (HRs) were calculated for risk of VTE following cholecystectomy using Cox regression. Results: 24,677 patients were identified with a rate of VTE in the first year following cholecystectomy of 2.80 per 1,000 person years (95% CI 2.18–3.59). Patients aged ≥70 vs. aged < 50 had 8.3-fold increase in risk of VTE (HR 8.27, 95% CI 3.72–18.35); patients with body mass index (BMI) > 30 vs. BMI < 30 had 2.4-fold increase in risk (HR 2.42, 95% CI 1.40–4.18); open vs. laparoscopic operation had 3-fold increase in risk (HR 2.94, 95% CI 1.55–5.55). Compared to general population, VTE risk was the highest in the first 30 days post-operatively with 9.9-fold risk following emergency cholecystectomy and 4.5-fold risk after inpatient cholecystectomy (HR 9.90, 95% CI 4.42–22.21; HR 4.54, 95% CI 2.85–7.21). Conclusions: Cholecystectomy is associated with a low absolute risk of VTE and we have identified high risk groups including the elderly, obese and those having open surgery.

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“…In contrast, there has been less discussion regarding latent and clinically undetectable PFO, including the so-called probe patency of the oval foramen [3], related to paradoxical cerebral embolism. Pediatric deep vein thrombosis occurs at a rate of 0.07 to 0.14 per 10,000 children [4] and is less frequent than in adults (approximately 2 to 20 per 10,000) [5]. The incidence increases markedly with age [5].…”

Section: Discussionmentioning

confidence: 99%

Pediatric acute paradoxical cerebral embolism with pulmonary embolism caused by extremely small patent foramen ovale

et al. 2018

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AbstractHerein, we report a pediatric case of acute paradoxical cerebral embolism complicated by serious acute pulmonary embolism that was caused by an extremely small patent foramen ovale (PFO). The patient had no medical history suggestive of any other reason.Paradoxical cerebral embolism may occur even with an extremely small PFO because of the increased right-side pressure of the heart and a resulting right-to-left shunt from the acute pulmonary embolism. Although pediatric cases of pulmonary embolism are rare, when diagnosed, clinicians should consider the risk of a concurrent paradoxical cerebral embolism resulting from a latent PFO. The possibility of PFO should be assessed extremely carefully in pediatric critical care by checking for a thrombogenesis tendency and the existence of deep vein thrombosis in the patient.

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Risk of venous thromboembolism in children after general surgery

Abstract: Background/Purpose

Cited by 17 publications

References 21 publications

Venous thromboembolism following inpatient pediatric surgery: Analysis of 153,220 patients

Venous thromboembolism following inpatient pediatric surgery: Analysis of 153,220 patients

Duration and Magnitude of Postoperative Risk of Venous Thromboembolism after Cholecystectomy: A Population-Based Cohort Study

Pediatric acute paradoxical cerebral embolism with pulmonary embolism caused by extremely small patent foramen ovale

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