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01-07-2016 | Original Article

Quality improvement program reduces venous thromboembolism in infants and children with long-gap esophageal atresia (LGEA)

Authors: Daniel P. Kelly, Sigrid Bairdain, David Zurakowski, Brenda Dodson, Kathy M. Harney, Russell W. Jennings, Cameron C. Trenor

Published in: Pediatric Surgery International | Issue 7/2016

Abstract

Purpose

Patients with long-gap esophageal atresia (LGEA) treated with the Foker process are at increased risk of venous thromboembolism (VTE). An institutional quality improvement program to decrease VTE risk factor exposure and utilize prophylactic anticoagulation was implemented. We aim to evaluate the efficacy and safety of a VTE risk-reduction program in patients with LGEA.

Methods

Implementation and evaluation of a VTE risk-reduction program in patients with LGEA from 2012 to 2015 was performed. Symptomatic VTE with radiographic confirmation were defined as events. Post-program characteristics were evaluated and compared to a historical cohort.

Results

Sixty-seven patients were identified. Two developed VTE (7 %) post-program implementation; compared to 13/40 (33 %) VTE incidence in the historical cohort (p = 0.018). Baseline demographics were similar, including age, esophageal atresia type and gap length. Post-protocol patients had fewer paralysis episodes (p = 0.004), paralysis days (p = 0.003), central venous catheters (p = 0.003), thoracotomies (p < 0.001), ventilator hours (p = 0.02), and decreased hospital (p < 0.001) and ICU stay (p < 0.001). All patients in the VTE risk-reduction program were exposed to prophylactic anticoagulation. No bleeding complications and/or thrombosis-related mortality occurred.

Conclusion

VTE risk-reduction program implementation decreased symptomatic VTE incidence with associated decreases in ICU and hospital length of stay. Prophylactic anticoagulation can be utilized safely in a complicated pediatric surgical population.

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Title: Quality improvement program reduces venous thromboembolism in infants and children with long-gap esophageal atresia (LGEA)
Authors: Daniel P. Kelly
Sigrid Bairdain
David Zurakowski
Brenda Dodson
Kathy M. Harney
Russell W. Jennings
Cameron C. Trenor
Publication date: 01-07-2016
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Surgery International / Issue 7/2016
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-016-3902-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Quality improvement program reduces venous thromboembolism in infants and children with long-gap esophageal atresia (LGEA)

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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