Background/purpose: Children with inflammatory bowel disease (IBD) have increased risk for venous thromboembolism (VTE). We sought to determine incidence and risk factors for postoperative VTE in a multicenter cohort of pediatric patients undergoing colorectal resection for IBD.
Methods: Retrospective review of children ≤18 years who underwent colorectal resection for IBD from 2010 to 2016 was performed at four children's hospitals. Primary outcome was VTE that occurred between surgery and last follow-up. Factors associated with VTE were determined using univariable and multivariable analyses.
Results: Two hundred seventy-six patients were included with median age 15 years [13,17]. Forty-two children (15%) received perioperative VTE chemoprophylaxis, and 88 (32%) received mechanical prophylaxis. DVT occurred in 12 patients (4.3%) at a median of 14 days postoperatively [8,147]. Most were portomesenteric (n = 9, 75%) with the remaining catheter-associated DVTs in extremities (n = 3, 25%). There was no association with chemoprophylaxis (p > 0.99). On Cox regression, emergent procedure [HR 18.8, 95%CI: 3.18-111], perioperative plasma transfusion [HR 25.1, 95%CI: 2.4-259], and postoperative infectious complication [HR 10.5, 95%CI: 2.63-41.8] remained predictive of DVT.
Conclusion: Less than 5% of pediatric IBD patients developed postoperative VTE. Chemoprophylaxis was not protective but rarely used. Patients with risk factors identified in this study should be monitored or given prophylaxis for VTE.
Level of evidence: Treatment Study, Level III.
Keywords: Colectomy; Deep venous thrombosis; Inflammatory bowel disease; Pediatric surgery.
Copyright © 2020 Elsevier Inc. All rights reserved.
Chemoprophylaxis in addition to mechanical prophylaxis after total knee arthroplasty surgery does not reduce the incidence of venous thromboembolism.Thromb J. 2019 Jun 20;17:9. doi: 10.1186/s12959-019-0200-1. eCollection 2019. Thromb J. 2019. PMID: 31249474 Free PMC article.
Venous thromboembolism following colorectal resection.Colorectal Dis. 2017 Apr;19(4):385-394. doi: 10.1111/codi.13529. Colorectal Dis. 2017. PMID: 27654996
Association of Perioperative Red Blood Cell Transfusions With Venous Thromboembolism in a North American Registry.JAMA Surg. 2018 Sep 1;153(9):826-833. doi: 10.1001/jamasurg.2018.1565. JAMA Surg. 2018. PMID: 29898202 Free PMC article. Clinical Trial.
Extended thromboprophylaxis following colorectal surgery in patients with inflammatory bowel disease: a comprehensive systematic clinical review.Colorectal Dis. 2019 Sep 6. doi: 10.1111/codi.14853. Online ahead of print. Colorectal Dis. 2019. PMID: 31490000 Review.
Venous thromboembolism prophylaxis in the pediatric trauma population.J Pediatr Surg. 2013 Jun;48(6):1413-21. doi: 10.1016/j.jpedsurg.2013.02.059. J Pediatr Surg. 2013. PMID: 23845640 Review.