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. 2020 Feb 20;S0022-3468(20)30121-4.
doi: 10.1016/j.jpedsurg.2020.02.020. Online ahead of print.

The Incidence of Venous Thromboembolism in Children Following Colorectal Resection for Inflammatory Bowel Disease: A Multi-Center Study

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The Incidence of Venous Thromboembolism in Children Following Colorectal Resection for Inflammatory Bowel Disease: A Multi-Center Study

Christina M Bence et al. J Pediatr Surg. .

Abstract

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.

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