VTE Risk Is Higher in Pediatric Abdominopelvic Surgery Patients

The risk for venous thromboembolism (VTE) in pediatric surgical patients is highest among those who receive abdominopelvic general surgery, are older than 15 years, have pre-existing renal failure or a diagnosis of septic shock, have an American Society of Anesthesia Classification of higher than 2, and/or receive anesthetic for more than 2 hours during surgery, according to a recent study.

Although VTE is rare among pediatric surgical patients, its prevalence has increased. Currently, there are many evidence-based guidelines for VTE screening and prevention in adult patients, but none for nonorthopedic or trauma pediatric surgical patients.
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For their study, the researchers assessed 218,432 pediatric surgical patients from 2012 to 2015. Patient data were obtained from the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database. Patient and operative variables were examined in order to identify those associated with VTE.

Results indicated that 238 (0.11%) patients had experienced VTE following surgical procedures. Of these patients, 28.6% had received abdominopelvic general surgery procedures. Multivariate regression demonstrated that, among these patients, the risk for VTE was higher among those who were older than 15 years, had pre-existing renal failure or a diagnosis of septic shock, had an American Society of Anesthesia Classification of higher than 2, and/or received anesthetic for more than 2 hours.

The researchers noted that malignancy, chemotherapy, inflammatory bowel disease, and laparoscopic surgical approach were not associated with an increased risk of VTE. Female sex was associated with an increased risk of VTE among all surgical patients. However, the difference was not found to be significant in general surgery procedures of the abdomen and the pelvis.

“In pediatric patients undergoing general surgery procedures, a model specifically incorporating the risk factors from this study will help identify patients at increased risk of VTE,” the researchers concluded. “Additional studies are needed to verify the application of these factors in a risk assessment model including comparison prophylaxis methods.”

—Christina Vogt

Reference:

Cairo SB, Naseem HUR, Rothstein DH. Risk factors for venous thromboembolic events in pediatric surgical patients: defining when prophylaxis is indicated. J Am Coll Surg. 2017;225(4):e139.  http://dx.doi.org/10.1016/j.jamcollsurg.2017.07.901.