title: Complications and 30-day Outcomes Associated With Venous Thromboembolism in the Pediatric Orthopaedic Surgical Population.
abstract: BACKGROUND
  The risk of morbidity associated with venous thromboembolism (VTE) after pediatric orthopaedic surgery remains unclear despite increased use of thromboprophylaxis measures.
  
  
  METHODS
  The American College of Surgeons National Surgical Quality Improvement Program, Pediatric database was queried for patients undergoing an orthopaedic surgical procedure between 2012 and 2013. Upper extremity and skin/subcutaneous surgeries were excluded. Associations between VTE and procedure, demographics, comorbidities, preoperative laboratory values, and 30-day postoperative outcomes were evaluated.
  
  
  RESULTS
  Of 14,776 cases, 15 patients (0.10%) experienced postoperative VTE. Deep vein thrombosis (DVT) occurred in 13 patients (0.09%), and pulmonary embolism developed in 2 patients (0.01%). The procedure with the highest VTE rate was surgery for infection (1.2%). Patient factors associated with the development of VTE included hyponatremia (P = 0.003), abnormal partial thromboplastin time (P = 0.046), elevated aspartate transaminase level (P = 0.004), and gastrointestinal (P = 0.011), renal (P = 0.016), and hematologic (P = 0.019) disorders. Nearly half (46.2%) of DVTs occurred postdischarge. Complications associated with VTE included prolonged hospitalization (P < 0.001), pneumonia (P < 0.001), unplanned intubation (P = 0.003), urinary tract infection (P = 0.003), and central line-associated bloodstream infection (P < 0.001). Most of the postoperative complications (66.7%) occurred before VTE diagnosis, and no patients with VTE died.
  
  
  CONCLUSIONS
  In the absence of specified risk factors, thromboprophylaxis may be unnecessary for this population.
authors: From the Department of Surgery, Division of Orthopaedic Surgery (Mr. Baker, Mr. Sherrod, Dr. Ponce, and Dr. Gilbert) and the Department of Epidemiology (Dr. McGwin), the University of Alabama at Birmingham, and the Children's Hospital of Alabama (Dr. Gilbert), Birmingham, AL.
authors: Dustin
authors: D
authors: Baker
authors: Brandon
authors: B
authors: Sherrod
authors: Gerald
authors: G
authors: McGwin
authors: Brent
authors: B
authors: Ponce
authors: Shawn
authors: S
authors: Gilbert
mesh_terms: D000293:Adolescent; D000925:Anticoagulants / Q000627:therapeutic use; D002648:Child; D015897:Comorbidity; D019992:Databases as Topic; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D019637:Orthopedic Procedures / Q000009:adverse effects*; D011379:Prognosis; D011655:Pulmonary Embolism / Q000453:epidemiology / Q000517:prevention & control; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000517:prevention & control
chemical_list: D000925:Anticoagulants