Thromboembolic complications in children after spinal fusion surgery

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.