Incidence of Deep Vein Thrombosis and Pulmonary Embolism in the Elective Pediatric Orthopaedic Patient.

BACKGROUND: Although venous thromboembolism (VTE) has been well studied in the pediatric trauma population, rates of VTE associated with elective pediatric orthopaedic procedures have not been addressed in current literature. The purpose of this retrospective study was to identify the incidence of VTE in the elective pediatric orthopaedic surgical population and delineate subsets of this population at greatest risk. This study may provide valuable data to begin the process of resolving the controversy surrounding deep vein thrombosis prophylaxis in the pediatric orthopaedic population. METHODS: The Pediatric Health Information System was queried for patients admitted on an ambulatory or inpatient basis, aged below 18 years, from January 2006 to March 2011 during which an elective orthopaedic surgery was the principal procedure performed. Patients with diagnoses or procedures related to infection, trauma, malignancy, or coagulopathies were excluded. Patients admitted through the emergency department or whose orthopaedic procedure was not performed on the admission date were excluded. Age, sex, ethnicity, race, admission year, and all procedures/diagnoses were recorded. The presence of VTE at the index admission or any subsequent readmission within 90 days was recorded. All criteria were coded using ICD-9-CM codes. Generalized logistic regression analyses were used to identify factors related to VTE. RESULTS: A total of 143,808 admissions (117,676 patients) matched the inclusion criteria. Thirty-three had a VTE during the index admission with an additional 41 at subsequent readmissions, for a total incidence of 0.0515% by admission and 0.0629% by patient. In the multivariable model, variables significantly (P<0.05) related to VTE included increasing age, admission type, diagnosis of metabolic conditions, obesity, and/or syndromes, and complications of implanted devices and/or surgical procedures. No procedure variables were significantly related to VTE in the multivariable model. CONCLUSIONS: The incidence of VTE in this cohort of pediatric patients undergoing elective orthopaedic surgery was 0.0515%. In children, underlying diagnosis seems to be a stronger predictor of VTE than procedures performed. Diagnosis with a metabolic condition, syndrome, and/or obesity, complications of implanted devices and/or surgical procedures, older age, and admission as an inpatient were significantly related to the development of a VTE. LEVEL OF EVIDENCE: Level IV­case series.

Discovery of hypospadias during newborn circumcision should not preclude completion of the procedure.

OBJECTIVE: To test the hypothesis that completion of newborn circumcision does not complicate hypospadias repair, and that circumcision will minimize future operations. STUDY DESIGN: Children referred for distal hypospadias over a 5-year period were grouped by presentation. Children with an aborted circumcision owing to concerns for hypospadias were subdivided into patients who underwent hypospadias repair (group 1a) and those who underwent circumcision (group 1b). Group 2 consisted of patients with a completed circumcision who underwent hypospadias repair. Children with traditionally recognized distal hypospadias served as controls. RESULTS: A total of 93 newborns had an aborted newborn circumcision. Of these, 28 underwent hypospadias repair (group 1a), and 47 underwent circumcision completion under general anesthesia (group 1b). The remaining 18 either deferred surgery or underwent in-office circumcision. Ten patients with hypospadias and an intact prepuce had a completed circumcision and subsequently underwent repair (group 2). The control group comprised 151 patients. No patients with a completed circumcision experienced complications after hypospadias repair, whereas the control group had a 5.3% rate of complications. CONCLUSION: Performing circumcision in newborns with hypospadias and an intact prepuce did not affect repair or the risk of complications. These findings, along with previous results, demonstrate that newborn circumcision can be safely completed in children with an intact prepuce. Furthermore, aborting a newborn circumcision after dorsal slit will expose a substantial number of children to additional procedures under general anesthesia.