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Quality improvement program reduces venous thromboembolism in infants and children with long-gap esophageal atresia (LGEA).
Kelly, Daniel P; Bairdain, Sigrid; Zurakowski, David; Dodson, Brenda; Harney, Kathy M; Jennings, Russell W; Trenor, Cameron C.
Afiliación
  • Kelly DP; Division of Medicine Critical Care, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, USA. Daniel.Kelly@childrens.harvard.edu.
  • Bairdain S; Department of Pediatric Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
  • Zurakowski D; Department of Pediatric Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
  • Dodson B; Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
  • Harney KM; Department of Pharmacy, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
  • Jennings RW; Division of Hematology and Oncology, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
  • Trenor CC; Department of Pediatric Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Pediatr Surg Int ; 32(7): 691-6, 2016 Jul.
Article en En | MEDLINE | ID: mdl-27262479
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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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Atresia Esofágica / Tromboembolia Venosa / Mejoramiento de la Calidad Tipo de estudio: Etiology_studies / Incidence_studies / Prognostic_studies / Risk_factors_studies Aspecto: Implementation_research Límite: Adolescent / Child / Child, preschool / Female / Humans / Infant / Male / Newborn País/Región como asunto: America do norte Idioma: En Revista: Pediatr Surg Int Asunto de la revista: PEDIATRIA Año: 2016 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Alemania
Texto completo
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XML
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Atresia Esofágica / Tromboembolia Venosa / Mejoramiento de la Calidad Tipo de estudio: Etiology_studies / Incidence_studies / Prognostic_studies / Risk_factors_studies Aspecto: Implementation_research Límite: Adolescent / Child / Child, preschool / Female / Humans / Infant / Male / Newborn País/Región como asunto: America do norte Idioma: En Revista: Pediatr Surg Int Asunto de la revista: PEDIATRIA Año: 2016 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Alemania