title: High incidence of catheter-associated venous thromboembolic events in patients with long gap esophageal atresia treated with the Foker process.
abstract: OBJECTIVE
  To determine the incidence of catheter-associated venous thromboembolic events (VTE) in long gap esophageal atresia (LGEA) patients treated at Boston Children's Hospital (BCH) and to identify possible risk factors associated with their development.
  
  
  METHODS
  We performed a retrospective analysis of LGEA patients from 2005 to 2012. Symptomatic VTEs with radiographic confirmation were defined as events. Potential risk factors were assessed by univariate analysis and multivariate logistic regression. Covariates included age, weight, initial gap length, cumulative days of pharmacologic paralysis and paralytic episodes, number and type of central venous catheters (CVCs), and number of operations.
  
  
  RESULTS
  Forty-four LGEA patients were identified. The incidence of CVC associated VTE was 34%. Univariate analysis identified age at Foker 1 (P=.03), paralysis duration (P=.01), episodes of paralysis (P=.001), cumulative number of CVC (P=.007) and length of stay (P=.03) as significant. Multivariate logistic regression identified the number of paralytic episodes as the only significant independent risk factor for VTE (P<.0001).
  
  
  CONCLUSIONS
  The incidence of symptomatic VTE was 34%, significantly higher than the VTE incidence of 4.5% reported for our other hospitalized children. These data have led to multidisciplinary discussions regarding thromboprophylaxis and development of a consensus-driven protocol. Since the initiation of this protocol, no VTEs have been identified.
authors: Department of Pediatric Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: sigrid.bairdain@childrens.harvard.edu.
authors: Sigrid
authors: S
authors: Bairdain
authors: Department of Anesthesia, Perioperative and Pain Medicine, Division of Critical Care Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors: Daniel P
authors: DP
authors: Kelly
authors: Department of Pediatric Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors: Corinne
authors: C
authors: Tan
authors: Department of Pharmacy, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors: Brenda
authors: B
authors: Dodson
authors: David
authors: D
authors: Zurakowski
authors: Department of Pediatric Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Anesthesia, Boston Children's Hospital, Harvard Medical School, Boston MA, USA.
authors: David
authors: D
authors: Zurakowksi
authors: Department of Pediatric Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors: Russell W
authors: RW
authors: Jennings
authors: Department of Medicine, Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors: Cameron C
authors: CC
authors: Trenor
mesh_terms: D001900:Boston / Q000453:epidemiology; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D004933:Esophageal Atresia / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000453:epidemiology*
keywords: Long gap esophageal atresia (LGEA); Paralysis; Venous thromboembolic events (VTE)