OC 65.4 - Examining pre-operative risk factors of hospital-acquired venous thromboembolism in a pediatric surgical population

Tuesday, June 25, 2024

15:30 – 15:45 ICT

Room: 110 A-C

Co-Author(s)

CP

Cameron Patterson

Research Student
Schulich School of Medicine and Dentistry, Western University
London, Ontario, Canada
RK

Ryan Katchky

Pediatric Surgeon
Division of Orthopaedic Surgery, Scarborough Health Network
London, Ontario, Canada
JD

Jacob Davidson

Research Coordinator
Division of Pediatric Surgery, Children’s Hospital, London Health Sciences Centre
London, Ontario, Canada
CW

Claire Wilson

Research Associate
Division of Pediatric Surgery, Children’s Hospital, London Health Sciences Centre
London, Ontario, Canada
Marie-Claude Pelland-Marcotte

Pediatric Hematologist/Oncologist
Division of Hematology-Oncology, CHU de Québec - Centre Mère-Enfant Soleil, Québec City
Quebec City, Quebec, Canada
JS

Julie Strychowsky

Pediatric Surgeon
Schulich School of Medicine and Dentistry, Western University
London, Ontario, Canada
JL

Jennifer Lam

Pediatric Surgeon
Schulich School of Medicine and Dentistry, Western University
London, Ontario, Canada

Presenting Author(s)

Soumitra Tole

Pediatric Hematologist/Oncologist
Schulich School of Medicine and Dentistry, Western University
London, Ontario, Canada

Background: Post-operative venous thromboembolism (VTE) in children is a rare but potentially serious surgical complication. There remains a paucity of evidence to identify at-risk patients and guide the use of thromboprophylaxis in children undergoing surgery.

Aims: To identify pre-operative patient and surgical risk factors for VTE in children undergoing surgery.

Methods: Patients aged 1-18 who underwent surgery between 2012-2021 were identified from the National Surgical Quality Improvement Program - Pediatric (NSQIP-P) participant user data files. NSQIP-P is an international, multi-specialty surgical database that collects demographic, surgical, and thirty-day outcome data from a sampling of more complex surgical cases at each center. Included variables were determined a priori based on clinical relevance. Multivariate logistic regression was used to identify pre-operative patient and surgical risk factors associated with VTE.

Results: 793 VTEs were identified in a total of 799,705 surgical encounters ( < 0.001%) and the overall rate of VTE did not change significantly over the study period (p=0.13). The median patient age was 9.8 years (interquartile range [IQR]: 5.0-13.9), and 54.1% were male. The strongest pre-operative predictors of VTE in the multivariate model were: inpatient status, oxygen support, steroid use, ventilator dependence, blood transfusion 48 hours prior to surgery, sepsis/septic shock, operative time greater than 90 minutes, malignancy, and being 14 years or older (Table 1). The model with these variables had strong discrimination (c-statistic: 0.84) and adequate model fit (p=0.058). Post-operative VTE was associated with an increased all cause mortality, post-operative bleeding, and hospital re-admission (Table 2).

Conclusion(s): VTE after pediatric surgery is rare but is associated with worse clinical outcomes. We identified major pre-operative VTE risk factors which could help guide the use of prophylactic anticoagulation. Development of a risk assessment model and prospective validation are needed to assess the safety and efficacy of VTE prophylaxis in at-risk surgical patients.