Introduction Venous thromboembolism (VTE) is a recognized postoperative complication in adults; however, limited data exist regarding VTE after surgery in children. The purpose of this study was to determine whether the incidence and associated clinical characteristics of pediatric VTE differ between orthopedic surgery-related (OSR) and non-orthopedic surgery-related (NSR) procedures. Methods Patients younger than 19 years with imaging-confirmed VTE (ultrasound (US) or computed tomography (CT)) within 30 days of an inpatient surgical procedure between January 1, 2009, and December 31, 2016, at Boston Children's Hospital, a single tertiary pediatric hospital in Boston, USA, were retrospectively identified. VTE was classified as OSR or NSR based on the index surgical procedure. The primary outcome was the incidence of VTE per 10,000 inpatient surgeries in the OSR and NSR cohorts. Secondary measures included VTE anatomic location and associated patient and procedural characteristics, including age, trauma, ambulatory status, central or peripherally inserted central catheter use, malignancy, infection, and clotting disorder or family history of VTE. Group differences were assessed using chi-square or Fisher’s exact tests with a significance level of 0.05. Results Among 233,339 inpatient surgical procedures, 86 VTE events were identified, corresponding to an overall incidence of 3.69 per 10,000 cases. The incidence was 5.56 per 10,000 in the OSR cohort and 3.22 per 10,000 in the NSR cohort. OSR VTEs occurred predominantly in the lower extremity, whereas NSR VTEs were more evenly distributed between the lower and upper extremities. Patients with OSR VTEs were older than those with NSR VTEs (mean age of 15.1 versus 7.9 years; p < 0.001). Trauma and non-ambulatory status were more common among OSR VTEs, whereas central or peripherally inserted central catheter use and malignancy were more frequent among NSR VTEs (all p < 0.05). Postoperative VTE prophylaxis was used more frequently in the NSR cohort than in the OSR cohort (p < 0.05). Conclusion Pediatric OSR and NSR VTEs differ in incidence, age distribution, anatomic pattern, and associated clinical context. Recognition of these cohort-specific profiles may support more informed perioperative assessment and vigilance in pediatric surgical patients.
Samineni et al. (Sat,) studied this question.