Dr. Inmaculada (Chichi) Aban, professor in the department of biostatistics at the University of Alabama at Birmingham School of Public Health collaborated with faculty from the UAB School of Medicine in the department of pediatrics and the Children’s Hospital of Alabama to evaluate venous thromboembolism ((VTE) rates and risk factors following inpatient pediatric surgery.
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.
[Photo: Dr. Inmaculada (Chichi) Aban]
305 patients (0.20 percent) developed 296 venous thromboses and 12 pulmonary emboli (3 cooccurrences). Median time to VTE was 9 days. Most VTEs (81 percent) occurred predischarge. Subspecialties with highest VTE rates were cardiothoracic (0.72 percent) and general surgery (0.28 percent). No differences were seen for elective vs. urgent/emergent procedures (p = 0.106). All-cause mortality VTE patients was 1.2 percent vs. 0.2 percent 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 LOSs 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).
The authors concluded that pediatric postsurgical patients have unique risk factors for developing VTE.