Incidence and Predictors for Postoperative Thrombotic Complications in Children With Surgical and Nonsurgical Heart Disease

Abstract

Background: Children with congenital heart disease are at increased risk of thrombotic complications (thrombosis and thromboembolism). This study sought to assess the incidence and predictors of thrombotic complications in children with surgical and nonsurgical heart diseases.

Methods: We performed a retrospective analysis of the Health Care Cost and Use Project Kid's Inpatient Database. Children with surgical and nonsurgical heart diseases were categorized into the following four subgroups: (1) septal defects, (2) single ventricle physiology, (3) right ventricle outflow tract obstruction, and (4) left ventricle outflow tract obstruction. Demographic information, comorbidities, and outcomes, such as mortality, acute kidney injury, sepsis, neurologic complications, thrombotic complications, extracorporeal membrane oxygenation, and ventricular assist device use, were identified. We used propensity-matched analysis and multivariate logistic regression analysis to determine the variables associated with thrombotic complications.

Results: After propensity-matched analysis, the incidence of thrombotic complications was 3.90% (947/24,251) in children with surgical and 2.13% (516/24,251) in children with nonsurgical heart disease (p < 0.001). Multivariate logistic regression analysis revealed that single ventricle physiology or right ventricle outflow tract obstruction, extracorporeal membrane oxygenation, ventricular assist device, acute kidney injury, sepsis, and the presence of a coagulopathy increased the risk of thrombotic complications in children with surgical or nonsurgical heart disease. Age younger than 1 year increased the risk of thrombotic complications in the surgical population, whereas age older than 12 years increased the risk in the nonsurgical population.

Conclusions: Children with both surgical and nonsurgical heart disease have increased risk of thrombotic complications. The risk is increased in patients with cyanotic heart disease and is highest in the presence of single ventricle physiology.