Investigators from multiple institutions conducted a retrospective study to assess the risk of venous thromboembolism (VTE) in children following scoliosis surgery. For the study, they abstracted data from a prospectively collected database on all scoliosis and kyphosis patients <19 years old who underwent primary spinal fusion and segmental instrumentations, or growing rod insertions, at a single institution between 1992 and 2019. Information collected on study participants included age, sex, type of scoliosis, type and duration of surgical procedures, length of hospital stay (LOS), and development of symptomatic deep venous thrombosis (DVT) or pulmonary embolism (PE) within 6 months after surgery. For patients with DVT and/or PE, clinical outcomes were documented. During the study period, there was no routine screening or pharmacologic prophylaxis for VTE at the study institution. Mechanical prophylaxis, including early mobilization and leg exercises, was routinely provided. Beginning in 2014, patients ≥14 years old were treated with sequential compression devices (SCD) postoperatively. Treatment with SCD postoperatively was expanded to patients <12 years old in 2016.
Data on 1,471 consecutive patients undergoing a total of 2,131 surgical procedures were analyzed. The mean age of study children at the time of surgery was 12.1 ±3.2 years, and 70% were females. The most common types of scoliosis were idiopathic (851 patients, 58%) and neuromuscular (378 patients, 26%). The 2,131 procedures included 1,287 posterior spine fusions with instrumentation, 250 same-day anterior and posterior procedures, 103 growing rod insertions, and 491 lengthening procedures. Mean operative time was 4 hours for anterior procedures and 4 hours, 26 minutes for posterior procedures, and mean LOS was 5.1 days.
A total of 2 patients developed a lower limb DVT within 6 months of surgery and no patients had PE, yielding an overall rate of VTE of 0.13%. Time from surgery until diagnosis of DVT in the 2 patients was 161 and 55 days, respectively. Neither developed a PE, however, one of these patients developed another DVT following additional spinal surgery.
The authors conclude that the risk of VTE postoperatively in pediatric patients undergoing scoliosis surgery is low and that postoperative mechanical prophylaxis is sufficient in most cases.
Dr Hennrikus has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
Spinal surgery is a known risk factor for DVT in adults.1,2 However, there are limited data evaluating the risk of DVT after pediatric scoliosis surgery, and the literature does not provide evidence-based recommendations for the use of pharmacologic prophylaxis after such surgery.3 Pharmacological prophylaxis has potential morbidity such as post-operative bleeding, hematoma, infection, and a return to the operating room.4 The authors of the current study aimed to determine the...