Incidence of postoperative thrombosis in children with surgical and non-surgical heart diseases
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OBJECTIVES: Congenital heart disease or CHD is a condition that affects 8 out of every 1,000 newborns. Every year more than 35,000 newborns are diagnosed with a congenital heart disease in the United States. Neonates and children with congenital heart disease are at increased risk for thrombotic events, especially those with a single ventricle physiology. The objective of this study was to assess the incidence and to identify the predictors of thrombosis in neonates and children with surgical and non-surgical heart diseases. METHODS: We performed a retrospective analysis of the Health Care and Cost Use Project Kid’s Inpatient Database. Neonates and children with a congenital heart disease were identified using the international classification of disease, 9th revision, clinical modification (ICD-9 CM) diagnostic codes, and grouped into two sub-categories of surgical heart and non-surgical heart diseases. These groups were further divided into four types of lesions: septal defects, single ventricle physiology, right ventricle outflow tract obstruction, and left ventricle outflow tract obstruction. Demographic characteristics, the presence of co-morbidities, the incidence of any thrombotic events, mortality rate, and the presence of additional complications such as acute kidney injury, sepsis, neurologic complications, the need for extracorporeal membrane oxygenation or ventricular assist device were also collected using ICD-9 CM codes. After propensity-matched analysis, neonates and children with a surgical congenital heart disease were compared with those with a non-surgical heart disease. We used uni- and multivariable logistic regression analysis to identify the predictors associated with the incidence of thrombotic events in both sub-group. RESULTS: In children with surgical heart disease, the incidence of thrombosis was 3.90%, compared with 2.13% in children with non-surgical heart disease. Furthermore, those with single ventricle physiology (surgical 2.13%; non-surgical 3.41%) or right ventricle outflow tract obstruction (surgical 1.54%; non-surgical 1.66) had the highest incidence of thrombosis. In addition to demographic characteristics (e.g. age) and the type of congenital heart disease, we observed that extracorporeal membrane oxygenation (ECMO) or ventricular assist device(VAD), the presence acute kidney injury, sepsis, and coagulopathy were strong predictors for the development of thrombotic events. CONCLUSIONS: Children with both surgical and non-surgical heart disease have an increased risk for thrombotic events, but those with a single ventricle physiology or a right ventricle outflow tract obstruction had a further increased risk.