Quality improvement program reduces venous thromboembolism in infants and children with long-gap esophageal atresia (LGEA).
OBJECTIVE
Patients with long-gap esophageal atresia (LGEA) treated with the Foker process are at increased risk of venous thromboembolism (VTE). An institutional quality improvement program to decrease VTE risk factor exposure and utilize prophylactic anticoagulation was implemented. We aim to evaluate the efficacy and safety of a VTE risk-reduction program in patients with LGEA.


METHODS
Implementation and evaluation of a VTE risk-reduction program in patients with LGEA from 2012 to 2015 was performed. Symptomatic VTE with radiographic confirmation were defined as events. Post-program characteristics were evaluated and compared to a historical cohort.


RESULTS
Sixty-seven patients were identified. Two developed VTE (7 %) post-program implementation; compared to 13/40 (33 %) VTE incidence in the historical cohort (p = 0.018). Baseline demographics were similar, including age, esophageal atresia type and gap length. Post-protocol patients had fewer paralysis episodes (p = 0.004), paralysis days (p = 0.003), central venous catheters (p = 0.003), thoracotomies (p < 0.001), ventilator hours (p = 0.02), and decreased hospital (p < 0.001) and ICU stay (p < 0.001). All patients in the VTE risk-reduction program were exposed to prophylactic anticoagulation. No bleeding complications and/or thrombosis-related mortality occurred.


CONCLUSIONS
VTE risk-reduction program implementation decreased symptomatic VTE incidence with associated decreases in ICU and hospital length of stay. Prophylactic anticoagulation can be utilized safely in a complicated pediatric surgical population.
Division of Medicine Critical Care, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, USA. Daniel.Kelly@childrens.harvard.edu.
Daniel P
DP
Kelly
Department of Pediatric Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Sigrid
S
Bairdain
Department of Pediatric Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.|Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
David
D
Zurakowski
Department of Pharmacy, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Brenda
B
Dodson
Division of Hematology and Oncology, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Kathy M
KM
Harney
Department of Pediatric Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Russell W
RW
Jennings
Division of Hematology and Oncology, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Cameron C
CC
Trenor
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004933:Esophageal Atresia / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D058996:Quality Improvement; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D054556:Venous Thromboembolism / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*
Long gap esophageal atresia; Safety; Thromboprophylaxis; Venous thromboembolism