Jain Amit, Karas Dominique J, Skolasky Richard L, Sponseller Paul D
From the Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
Spine (Phila Pa 1976). 2014 Jul 15;39(16):1325-9. doi: 10.1097/BRS.0000000000000402.
Retrospective review.
To identify the incidence of venous thromboembolic (VTE) complications and pulmonary embolism (PE) in children undergoing spinal fusion surgery, to report associated mortality, and to analyze factors associated with their development.
The incidence of these complications after pediatric spinal fusion surgery is unknown.
The Nationwide Inpatient Sample database was queried from 2001 through 2010 to identify children (≤18 yr) who had spinal fusion surgery. Patients who had deep venous thrombosis or PE during the hospital stay were identified using appropriate International Classification of Diseases, Ninth Revision, Clinical Modification codes. Univariate and multivariate logistic regression models were used for analysis; statistical significance was set at P less than 0.05.
Depending on the year, the incidence of VTE in children varied from 9.6 to 38.5 events per 10,000 spinal fusions (mean: 21 events per 10,000 spinal fusions), and the incidence of PE varied from 0 to 6 events per 10,000 spinal fusions (mean: 2 events per 10,000 spinal fusions); there were no in-hospital VTE-associated mortalities. On multivariate logistic regression analysis, only patient diagnosis was found to be significantly associated with VTE development. VTE incidence was significantly higher in children with congenital scoliosis, syndromic scoliosis/kyphoscoliosis, and thoracolumbar fractures than in children with idiopathic scoliosis (odds ratios: 4.21, 7.14, and 12.59, respectively). On univariate analysis, in addition to diagnosis, age was also found to be significantly associated with VTE development. For each year of age, the VTE incidence increased 1.37-fold (P < 0.01).
The incidence of thromboembolic complications in children was approximately 21 events per 10,000 spinal fusions. A higher incidence of VTE in children was associated with older age and certain diagnoses (congenital scoliosis, syndromic scoliosis/kyphoscoliosis, and thoracolumbar fractures). PE in children was rare and not associated with fatality.
回顾性研究。
确定接受脊柱融合手术儿童静脉血栓栓塞（VTE）并发症和肺栓塞（PE）的发生率，报告相关死亡率，并分析与其发生相关的因素。
小儿脊柱融合手术后这些并发症的发生率尚不清楚。
查询2001年至2010年全国住院患者样本数据库，以确定接受脊柱融合手术的儿童（≤18岁）。使用适当的国际疾病分类第九版临床修订本代码识别住院期间发生深静脉血栓形成或PE的患者。采用单因素和多因素逻辑回归模型进行分析；统计学显著性设定为P小于0.05。
根据年份不同，儿童VTE的发生率为每10000例脊柱融合手术中有9.6至38.5例（平均：每10000例脊柱融合手术中有21例），PE的发生率为每10000例脊柱融合手术中有0至6例（平均：每10000例脊柱融合手术中有2例）；住院期间无VTE相关死亡病例。多因素逻辑回归分析显示，仅患者诊断与VTE发生显著相关。先天性脊柱侧凸、综合征性脊柱侧凸/后凸脊柱侧凸和胸腰椎骨折患儿的VTE发生率显著高于特发性脊柱侧凸患儿（比值比分别为4.21、7.14和12.59）。单因素分析显示，除诊断外，年龄也与VTE发生显著相关。每增加一岁，VTE发生率增加1.37倍（P<0.01）。
儿童血栓栓塞并发症的发生率约为每10000例脊柱融合手术中有21例。儿童VTE发生率较高与年龄较大及某些诊断（先天性脊柱侧凸、综合征性脊柱侧凸/后凸脊柱侧凸和胸腰椎骨折）有关。儿童PE罕见且与死亡无关。
