You could be reading the full-text of this article now if you...

If you have access to this article through your institution,
you can view this article in

Thromboembolic Complications in Children After Spinal Fusion Surgery

Jain, Amit MD; Karas, Dominique J. MHS; Skolasky, Richard L. ScD; Sponseller, Paul D. MD

Spine:
doi: 10.1097/BRS.0000000000000402
Surgery
Abstract

Study Design. Retrospective review.

Objective. 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.

Summary of Background Data. The incidence of these complications after pediatric spinal fusion surgery is unknown.

Methods. 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.

Results. 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).

Conclusion. 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.

Level of Evidence: 2

In Brief

The incidence of thromboembolic complications in children is approximately 21 events per 10,000 spinal fusions. A higher incidence of thromboembolic complications in children is associated with older age and diagnoses of congenital scoliosis, syndromic scoliosis/kyphoscoliosis, and thoracolumbar fractures.

Author Information

From the Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.

Address correspondence and reprint requests to Paul D. Sponseller, MD, c/o Elaine P. Henze, BJ, ELS, Medical Editor and Director, Editorial Services, Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Ave, A665, Baltimore, MD 21224; E-mail: ehenze1@jhmi.edu

Acknowledgment date: March 13, 2013. First revision date: July 15, 2013. Second revision date: October 28, 2013. Third revision date: March 11, 2014. Fourth revision date: April 18, 2014. Acceptance date: April 21, 2014.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: consultancy, grants/grants pending, and royalties.

© 2014 by Lippincott Williams & Wilkins