Orthopedics. 2022 Jan-Feb;45(1):31-37. doi: 10.3928/01477447-20211124-06. Epub 2021 Dec 2.
Venous thromboembolism (VTE) is an uncommon but highly morbid and potentially preventable complication in children. This study aimed to characterize the incidence of, and risk factors for, VTE in children undergoing orthopedic surgery. A retrospective analysis was performed using the 2012 to 2017 American College of Surgeons National Surgical Quality Improvement Program Pediatric (NSQIP-P) database. Patient demographics, comorbidities, operative variables, and perioperative outcomes were compared between patients who did and did not develop a VTE. In total, 81,490 pediatric patients who underwent orthopedic surgery were identified. Of those, the mean±SD age was 9.7±4.8 years, and 50.1% were male. Sixty patients (0.07%) developed a postoperative VTE. On multivariate regression, demographic and surgical variables associated with a VTE were ages 16 to 18 years (=.002; compared with ages 11 to 15 years), American Society of Anesthesiologists (ASA) classes III and V (=.003; compared with ASA classes I and II), preoperative blood transfusion (<.001), arthrotomy (<.001), and femur fracture (<.001). Postoperative adverse events occurring prior to a VTE were also assessed. Controlling for patient factors, independent risk factors for VTE included any adverse event (<.001), major adverse events (<.001), minor adverse events (<.001), reoperation (<.001), and readmission (<.001). This study identified an incidence of VTE of 0.07% in a population of more than 80,000 children undergoing orthopedic surgery. The identification of risk factors for VTE in this patient population raises the issue of VTE prophylaxis for select high-risk subpopulations. [. 2022;45(1):31-37.].
静脉血栓栓塞症（VTE）是儿童中罕见但高度病态和潜在可预防的并发症。本研究旨在描述接受骨科手术的儿童中 VTE 的发生率和危险因素。使用 2012 年至 2017 年美国外科医师学会全国外科质量改进计划儿科（NSQIP-P）数据库进行回顾性分析。比较了发生和未发生 VTE 的患者的患者人口统计学、合并症、手术变量和围手术期结局。共确定了 81490 名接受骨科手术的儿科患者。其中，平均年龄为 9.7±4.8 岁，50.1%为男性。60 名患者（0.07%）发生术后 VTE。多元回归分析显示，与 11 至 15 岁年龄组相比，16 至 18 岁年龄组（=0.002）、美国麻醉医师协会（ASA）分级 III 和 V 级（=0.003）、术前输血（<0.001）、关节切开术（<0.001）和股骨干骨折（<0.001）与 VTE 相关。还评估了 VTE 发生前发生的术后不良事件。控制患者因素后，VTE 的独立危险因素包括任何不良事件（<0.001）、重大不良事件（<0.001）、轻微不良事件（<0.001）、再次手术（<0.001）和再入院（<0.001）。本研究在 80000 多名接受骨科手术的儿童中发现 VTE 的发生率为 0.07%。在该患者人群中确定 VTE 的危险因素引发了针对特定高危亚人群的 VTE 预防问题。[2022；45（1）：31-37。]。
