Adolescents undergoing knee arthroscopy had a 0.8% risk of venous thromboembolism compared with 1.5% in adults, according to a recent study.
Findings
Recent data show that venous thromboembolism (VTE) cases among adolescents are increasing, with rates in those aged 13 to 16 nearing those seen in adults. In addition, the results, which were published in the Journal of Pediatric Orthopaedics, showed that the 90-day incidence of deep vein thrombosis (DVT) was 1.3% in adults compared with 0.8% in adolescents, and pulmonary embolism occurred in 0.3% of adults vs 0.2% of adolescents after matching. Subgroup analysis confirmed these trends: adults undergoing anterior cruciate ligament and meniscus surgeries experienced higher rates of thromboembolic events compared with adolescents. The 0.8% VTE rate found in this study exceeds earlier estimates of 0.27% and 0.25% for adolescents after knee arthroscopy. The authors noted that these and other differences in VTE incidence rate likely reflect variations in patient selection, procedure type, and prophylaxis use.
Despite the higher risk found in adults, univariate analysis identified significant VTE risk factors among adolescents. Oral contraceptive use and obesity were associated with more than threefold increased risk, tobacco use with nearly a 24-fold risk, and diabetes mellitus with more than a 34-fold risk. Sex was not a significant factor. Regarding prophylaxis, 24% of adults received pharmacologic agents after surgery compared with 20% of adolescents. Aspirin was the most common agent and was administered to 23% of adults and 19% of adolescents. Other anticoagulants, including enoxaparin, heparin, and rivaroxaban, were used less frequently overall but at higher rates in adults than in adolescents.
“Given the high VTE rate identified and strong associations between risk factors such as diabetes, tobacco usage, and obesity, our findings underscore the need to re-evaluate VTE prophylaxis practices for adolescents undergoing knee arthroscopy,” noted lead author Mehul M. Mittal, BBA, of the Department of Orthopaedics at the University of Texas Southwestern Medical Center in Dallas, and colleagues. Routine prophylaxis may not be necessary for all adolescents undergoing knee arthroscopy, but adolescents with diabetes, tobacco use, obesity, or oral contraceptive use should be considered for more aggressive prophylaxis, they wrote. Adolescent-specific screening tools could also improve risk identification and outcomes.
Methods
The researchers conducted a large retrospective cohort study to assess VTE risk after arthroscopic knee surgery in adolescents compared with adults. Using the TriNetX Research Network, the investigators analyzed 301,585 patients who underwent knee arthroscopy between January 2003 and January 2023. Of these, 29,984 were adolescents aged 14 to 17 years and 271,601 were adults 18 years or older. Propensity score matching was applied to balance cohorts by sex and relevant comorbidities, including diabetes mellitus, obesity, oral contraceptive use, and tobacco use, and yielded matched groups of 29,984 patients each. Outcomes were assessed at 90 days postoperatively.
The authors added that, because pediatric-specific data are limited, some clinicians apply adult guidelines for adolescent VTE management, while others use institution-specific screening tools. These differing approaches may miss important age-related differences and highlight the need for standardized, evidence-based guidelines, they wrote. They cited a cost-efficient VTE screening tool that was used before lower extremity arthroscopy at a single institution and identified 30% more risk factors. Routine use of similar tools may improve VTE risk detection in adolescents and support better prophylaxis and outcomes, they said.
The researchers reported no conflicts of interest.
