Abstract
Background: The infectious risk of central venous line (CVL) placement in children with neutropenia (absolute neutrophil count [ANC] < 500/mm3) is not well defined. This study aims to investigate the early (≤ 30 days) and late (> 30 days) infectious complications of CVLs placed in pediatric patients with and without neutropenia. Methods: A retrospective review was conducted of all CVLs placed by pediatric surgeons at two institutions from 2010 to 2017. Multivariable logistic regression was performed to identify risk factors for line infection. Propensity score-matched cohorts of patients with and without neutropenia were compared in a 1:1 ratio. Wilcoxon rank-sum, Chi-square, Fisher's exact, and log-rank tests were also performed. Results: Review identified 1,102 CVLs placed in 937 patients. Fifty-four patients were neutropenic at the time of placement. Multivariable analysis demonstrated tunneled catheters and subclavian access as associated with line infection. The propensity score-matched cohort included 94 patients, 47 from each group. Demographic and preoperative data were similar between the groups (p > 0.05). Patients with neutropenia were no more likely to develop early (4.3% vs. 2.1%, p = 1.000) or late (19.1% vs. 17.0%, p = 1.000) infectious complications than patients without neutropenia, with similar median time to infection (141 vs. 222 days, p = 0.370). Conclusion: A policy of selective CVL placement in neutropenic patients with standardized postoperative line maintenance is safe. Future directions include defining criteria by which neutropenic patients could be prospectively selected for safe CVL placement. Level of Evidence: II – Retrospective cohort study.
| Original language | English (US) |
|---|---|
| Journal | Journal of pediatric surgery |
| DOIs | |
| State | Accepted/In press - Jan 1 2019 |
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Keywords
- Bloodstream infection
- Central line
- Neutropenia
- Propensity score-matching
ASJC Scopus subject areas
- Surgery
- Pediatrics, Perinatology, and Child Health
Cite this
Perioperative neutropenia is not an independent risk factor for infectious complications of central venous line placement in children : A propensity score-matched analysis. / Cunningham, Aaron J.; McClellan, Kristen V.; Dewey, Elizabeth; Krishnaswami, Sanjay; Butler, Marilyn; Nolt, Dawn; Fialkowski, Elizabeth; Haag, Meredith C.; Hamilton, Nicholas.
In: Journal of pediatric surgery, 01.01.2019.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Perioperative neutropenia is not an independent risk factor for infectious complications of central venous line placement in children
T2 - A propensity score-matched analysis
AU - Cunningham, Aaron J.
AU - McClellan, Kristen V.
AU - Dewey, Elizabeth
AU - Krishnaswami, Sanjay
AU - Butler, Marilyn
AU - Nolt, Dawn
AU - Fialkowski, Elizabeth
AU - Haag, Meredith C.
AU - Hamilton, Nicholas
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Background: The infectious risk of central venous line (CVL) placement in children with neutropenia (absolute neutrophil count [ANC] < 500/mm3) is not well defined. This study aims to investigate the early (≤ 30 days) and late (> 30 days) infectious complications of CVLs placed in pediatric patients with and without neutropenia. Methods: A retrospective review was conducted of all CVLs placed by pediatric surgeons at two institutions from 2010 to 2017. Multivariable logistic regression was performed to identify risk factors for line infection. Propensity score-matched cohorts of patients with and without neutropenia were compared in a 1:1 ratio. Wilcoxon rank-sum, Chi-square, Fisher's exact, and log-rank tests were also performed. Results: Review identified 1,102 CVLs placed in 937 patients. Fifty-four patients were neutropenic at the time of placement. Multivariable analysis demonstrated tunneled catheters and subclavian access as associated with line infection. The propensity score-matched cohort included 94 patients, 47 from each group. Demographic and preoperative data were similar between the groups (p > 0.05). Patients with neutropenia were no more likely to develop early (4.3% vs. 2.1%, p = 1.000) or late (19.1% vs. 17.0%, p = 1.000) infectious complications than patients without neutropenia, with similar median time to infection (141 vs. 222 days, p = 0.370). Conclusion: A policy of selective CVL placement in neutropenic patients with standardized postoperative line maintenance is safe. Future directions include defining criteria by which neutropenic patients could be prospectively selected for safe CVL placement. Level of Evidence: II – Retrospective cohort study.
AB - Background: The infectious risk of central venous line (CVL) placement in children with neutropenia (absolute neutrophil count [ANC] < 500/mm3) is not well defined. This study aims to investigate the early (≤ 30 days) and late (> 30 days) infectious complications of CVLs placed in pediatric patients with and without neutropenia. Methods: A retrospective review was conducted of all CVLs placed by pediatric surgeons at two institutions from 2010 to 2017. Multivariable logistic regression was performed to identify risk factors for line infection. Propensity score-matched cohorts of patients with and without neutropenia were compared in a 1:1 ratio. Wilcoxon rank-sum, Chi-square, Fisher's exact, and log-rank tests were also performed. Results: Review identified 1,102 CVLs placed in 937 patients. Fifty-four patients were neutropenic at the time of placement. Multivariable analysis demonstrated tunneled catheters and subclavian access as associated with line infection. The propensity score-matched cohort included 94 patients, 47 from each group. Demographic and preoperative data were similar between the groups (p > 0.05). Patients with neutropenia were no more likely to develop early (4.3% vs. 2.1%, p = 1.000) or late (19.1% vs. 17.0%, p = 1.000) infectious complications than patients without neutropenia, with similar median time to infection (141 vs. 222 days, p = 0.370). Conclusion: A policy of selective CVL placement in neutropenic patients with standardized postoperative line maintenance is safe. Future directions include defining criteria by which neutropenic patients could be prospectively selected for safe CVL placement. Level of Evidence: II – Retrospective cohort study.
KW - Bloodstream infection
KW - Central line
KW - Neutropenia
KW - Propensity score-matching
UR - http://www.scopus.com/inward/record.url?scp=85071987261&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85071987261&partnerID=8YFLogxK
U2 - 10.1016/j.jpedsurg.2019.08.005
DO - 10.1016/j.jpedsurg.2019.08.005
M3 - Article
AN - SCOPUS:85071987261
JO - Journal of Pediatric Surgery
JF - Journal of Pediatric Surgery
SN - 0022-3468
ER -