Perioperative neutropenia is not an independent risk factor for infectious complications of central venous line placement in children: A propensity score-matched analysis

Aaron J. Cunningham, Kristen V. McClellan, Elizabeth Dewey, Sanjay Krishnaswami, Marilyn Butler, Dawn Nolt, Elizabeth Fialkowski, Meredith C. Haag, Nicholas Hamilton

Research output: Contribution to journalArticle

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 languageEnglish (US)
JournalJournal of pediatric surgery
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Propensity Score
Neutropenia
Infection
Pediatrics
Neutrophils
Cohort Studies
Catheters
Retrospective Studies
Logistic Models
Maintenance
Demography

Keywords

  • Bloodstream infection
  • Central line
  • Neutropenia
  • Propensity score-matching

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

@article{8cb72e53d7234475ab179b01f7db09c1,
title = "Perioperative neutropenia is not an independent risk factor for infectious complications of central venous line placement in children: A propensity score-matched analysis",
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.",
keywords = "Bloodstream infection, Central line, Neutropenia, Propensity score-matching",
author = "Cunningham, {Aaron J.} and McClellan, {Kristen V.} and Elizabeth Dewey and Sanjay Krishnaswami and Marilyn Butler and Dawn Nolt and Elizabeth Fialkowski and Haag, {Meredith C.} and Nicholas Hamilton",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.jpedsurg.2019.08.005",
language = "English (US)",
journal = "Journal of Pediatric Surgery",
issn = "0022-3468",
publisher = "W.B. Saunders Ltd",

}

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

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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 -