Risk of Venous Thromboembolism in Adolescents Undergoing Pelvic Osteotomy: Insights From a Propensity-matched Retrospective Cohort Study.

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY Accounts of Chemical Research Pub Date : 2024-10-04 DOI:10.1097/BPO.0000000000002836

Mehul M Mittal, Tiffany M Lee, Katalina V Acevedo, Pooya Hosseinzadeh

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Abstract

Background: Pelvic osteotomies are surgical procedures that are commonly performed in adolescents and young adults to improve stability or correct various deformities. Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), are dreaded complications of any major procedure including pelvic osteotomies. Unlike adults, the incidence of DVT and need for prophylactic measures are not well understood in the adolescents. The purpose of this study is to understand the need for VTE prophylaxis in adolescents and determine if their risk profile aligns with adults, who have more established VTE prophylactic guidelines in place for these surgeries.

Methods: This retrospective cohort study utilized data from the TriNetX Research Network, which includes records from over 80 healthcare organizations and more than 120 million patients. De-identified patient data from January 1, 2003, to March 1, 2024, were extracted using relevant ICD-9 and ICD-10 procedural codes. The study included 2 cohorts: patients aged 13 to 17 years (adolescents) and patients 18 years and older (adults) who underwent pelvic osteotomies. To control for confounding variables, propensity score matching was employed based on sex and relevant comorbidities, including diabetes mellitus, tobacco use, and overweight/obesity. Statistical significance was set at P<0.01.

Results: A total of 2374 patients successfully matched in each cohort. Within 90 days following surgical intervention, adult patients had overall risks of 4.5%, 1.9%, and 5.9%, whereas adolescent patients had overall risks of 1.3%, 0.5%, and 1.4% for DVT (RR: 3.419), PE (RR: 4.182), and either DVT or PE (RR: 4.118), respectively.

Conclusions: This study examines the rate of VTE in a large cohort of adolescents undergoing pelvic osteotomies. Although we found the rates to be lower in adolescents compared with adults, the high absolute risk in adolescents-above 1%, the threshold established in the literature for considering prophylaxis-underscores the need for tailored risk stratification strategies and targeted thromboprophylaxis protocols for this population.

Levels of evidence: Level III: case-control study or retrospective cohort study.

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接受骨盆截骨术的青少年发生静脉血栓栓塞的风险：倾向匹配回顾性队列研究的启示。

背景：骨盆截骨术是青少年和年轻成年人常用的外科手术，目的是提高稳定性或矫正各种畸形。静脉血栓栓塞症（VTE），包括肺栓塞（PE）和深静脉血栓形成（DVT），是包括骨盆截骨术在内的任何大型手术的可怕并发症。与成人不同，青少年深静脉血栓的发病率和预防措施的必要性还不十分清楚。本研究的目的是了解青少年对 VTE 预防措施的需求，并确定他们的风险状况是否与成年人一致，因为成年人对这些手术有更成熟的 VTE 预防指南：这项回顾性队列研究利用了 TriNetX 研究网络的数据，该网络包括来自 80 多家医疗机构和 1.2 亿多名患者的记录。使用相关的 ICD-9 和 ICD-10 程序代码提取了 2003 年 1 月 1 日至 2024 年 3 月 1 日的去身份化患者数据。研究包括两个组群：13 至 17 岁（青少年）和 18 岁及以上（成人）接受骨盆截骨术的患者。为了控制混杂变量，研究人员根据性别和相关合并症（包括糖尿病、吸烟和超重/肥胖）进行了倾向评分匹配。统计显著性设定为 PResults：每个队列中共有 2374 名患者成功配对。手术干预后 90 天内，成人患者发生深静脉血栓（RR：3.419）、PE（RR：4.182）和深静脉血栓或 PE（RR：4.118）的总体风险分别为 4.5%、1.9% 和 5.9%，而青少年患者发生深静脉血栓（RR：3.419）、PE（RR：4.182）和深静脉血栓或 PE（RR：4.118）的总体风险分别为 1.3%、0.5% 和 1.4%：本研究调查了一大批接受骨盆截骨术的青少年的 VTE 发生率。尽管我们发现青少年的VTE发生率低于成人，但青少年的绝对风险很高，超过了1%（文献中规定的考虑预防的临界值），这表明有必要为这一人群量身定制风险分层策略和有针对性的血栓预防方案：三级：病例对照研究或回顾性队列研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.