Risk of venous thromboembolism in pediatric hospitalized patients undergoing noncardiac surgery: A report from the Children's Hospital‐Acquired Thrombosis consortium

Abstract

BackgroundSurgery is a known risk factor for hospital‐acquired venous thromboembolism (HA‐VTE) in children. ObjectivesTo assess whether the odds of HA‐VTE differs across six anatomic sites of noncardiac surgery and to identify risk factors for HA‐VTE in these children. Methodswas a multicenter, case–control study. Anatomic sites of surgery and risk factors for HA‐VTE were collected on hospitalized pediatric patients who had undergone a single noncardiac surgery and developed HA‐VTE (cases), and those who did not develop HA‐VTE (controls), via the Children's Hospital‐Acquired Thrombosis (CHAT) Registry. Logistic regression estimated the odds ratio (OR) and 95% confidence intervals (CIs) between six anatomic sites of surgery and 16 putative HA‐VTE risk factors. Variables with a p value of 0.10 or less in unadjusted analyses were included in adjusted models for further evaluation. The final model used backward selection, with a significance level of 0.05. ResultsFrom January 2012 to March 2020, 163 cases (median age, 5.7 years; interquartile range [IQR], 0.3–14.2) and 208 controls (median age of 7.5 years; IQR, 3.7–12.9) met our criteria. There was no statistically significant increased odds of VTE among the types of noncardiac surgery. In the final adjusted model, central venous catheter (CVC; OR, 14.69; 95% CI, 7.06–30.55), intensive care unit (ICU) stay (OR, 5.31; 95% CI, 2.53–11.16), and hospitalization in the month preceding surgery (OR, 2.75; 95% CI, 1.24–6.13) were each independently significant risk factors for HA‐VTE. ConclusionIn children undergoing noncardiac surgery, placement of CVCs, admission/transfer to the ICU, or hospitalization in the month prior to surgery were positively associated with HA‐VTE.