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No Association of Sirolimus with Wound Complications in Children with Vascular Anomalies

Published:November 23, 2022DOI:https://doi.org/10.1016/j.jpedsurg.2022.11.009

      Highlights

      • The transplant literature has identified an association between sirolimus therapy and wound complications, but similar studies have not been performed in children with vascular anomalies.
      • Sirolimus may not significantly increase perioperative complication rates (including wound complications) in pediatric patients undergoing resection of their vascular anomaly.

      Abstract

      Introduction

      Sirolimus has demonstrated effectiveness as a treatment option for several types of vascular anomalies; however, it has a potential side effect of delayed surgical wound healing. The purpose of this study was to evaluate the association of sirolimus with postoperative complications in the pediatric vascular anomaly population.

      Methods

      A retrospective cohort study was performed for children with a vascular anomaly who underwent excision or debulking of the anomaly from 2015 to 2020. Patient demographics, vascular anomaly characteristics, operative variables, sirolimus dosing information, and perioperative outcomes were collected. Univariate analysis was performed to compare outcomes based on the administration of sirolimus.

      Results

      Forty-seven patients with vascular anomalies underwent 57 surgical procedures (36 without perioperative sirolimus, 21 with perioperative sirolimus). The median age at the time of surgery was seven years (IQR 1.7 – 14.0). The most common anomalies were lymphatic and venolymphatic malformations. Of the patients administered perioperative sirolimus, the median preoperative and postoperative sirolimus levels were comparable (preoperative 6.9 ng/mL (IQR 4.9– 10.1), postoperative 6.5 ng/mL (IQR 4.7–9.4)). The rate of postoperative complications (sirolimus 19%, without sirolimus 11%; p=0.45) and wound complications (sirolimus 14%, without sirolimus 6%; p=0.26) were comparable between the cohorts.

      Conclusion

      Our results suggest sirolimus may not significantly increase perioperative complication rates in pediatric patients undergoing resection of their vascular anomaly.

      Keywords

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