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The indication for perioperative red blood cell transfusions is a predictive risk factor for severe postoperative
Ariane Willems1, Céline Van Lerberghe2, Kimberly Gonsette2
1Paediatric Intensive Care Unit, Department of Paediatrics, University Children's Hospital Queen Fabiola, Brussels, Belgium ariane.willems@huderf.be.
Insights
Red blood cell transfusions for therapeutic reasons, not just to maintain hematocrit during cardiac surgery, are linked to increased severe postoperative morbidity or mortality in children. This highlights the importance of transfusion indication in pediatric cardiac surgery outcomes.
Area of Science:
- Cardiology
- Pediatric Surgery
- Transfusion Medicine
Background:
- Red blood cell (RBC) transfusions in pediatric cardiac surgery serve two main purposes: treating hemorrhage/improving oxygen delivery (therapeutic) or maintaining hematocrit during cardiopulmonary bypass (CPB-driven).
- The specific indication for RBC transfusion may influence patient outcomes, but this has not been extensively studied in pediatric populations.
Purpose of the Study:
- To investigate whether the reason for red blood cell transfusion impacts severe postoperative morbidity or mortality in children undergoing cardiac surgery.
- To compare outcomes between therapeutic RBC transfusions and CPB-driven RBC transfusions.
Main Methods:
- Retrospective cohort study of pediatric patients undergoing cardiac surgery between 2006 and 2009.
- Comparison of patients receiving therapeutic transfusions versus CPB-driven transfusions.
- Multivariable logistic regression analysis to identify independent risk factors for severe postoperative morbidity or mortality, adjusted for relevant clinical variables.
Main Results:
- Patients receiving therapeutic transfusions had significantly higher rates of severe postoperative morbidity or mortality (48%) compared to CPB-driven transfusions (26%).
- Transfusion indication group was an independent risk factor for severe postoperative morbidity or mortality, even after adjustment.
- Therapeutic transfusion was associated with increased risk (OR 2.0), higher rates of infection, neurological deficit, and longer durations of mechanical ventilation and hospital stay.
Conclusions:
- The indication for red blood cell transfusion significantly influences the occurrence of severe postoperative morbidity or mortality in pediatric cardiac surgery patients.
- Therapeutic transfusions are associated with worse outcomes compared to CPB-driven transfusions.
- This finding underscores the need to carefully consider transfusion strategies in pediatric cardiac surgery.
Objectives:
In paediatric cardiac surgery, red blood cell (RBC) transfusions are given to treat haemorrhage or to increase oxygen delivery (therapeutic transfusion). Sometimes, RBCs are added to the prime solution to avoid a too low haematocrit on bypass (CPB-driven transfusion). Our study investigated whether the reason for RBC transfusion might affect severe postoperative morbidity or mortality.
Methods:
This retrospective cohort study was conducted in a tertiary care level, children's hospital. The charts of all patients admitted between 2006 and 2009 were reviewed. Among transfused patients, children receiving a therapeutic transfusion were compared with those receiving a CPB-driven transfusion. The primary outcome was severe postoperative morbidity or mortality. Statistically significant variables founded with univariate analysis were incorporated in the multivariable logistic regression analysis to build a model that predicts severe postoperative morbidity or mortality. This model was then adjusted for clinically relevant variables that may interfere with 'indication for transfusion'.
Results:
One hundred and one (48%) patients in the therapeutic and 92 (26%) patients in the CPB-driven transfusion group developed severe postoperative morbidity or died (P < 0.001). A multivariable logistic regression showed that weight, ASA, calculated blood loss, intraoperative fluid balance, duration of CPB time and the indication group for transfusion [1.64 (1.03-2.62); P = 0.039] were independent risk factors for severe postoperative morbidity or mortality. The indication group for transfusion remained significant [2.0 (1.16-3.45); P = 0.013] after adjustment for significant predictors of indication for transfusion. Number of patients with infections, or neurological deficit, and length of mechanical ventilation, PICU and hospital length of stay, were significantly higher in the therapeutic compared with the CPB-driven transfusion group one.
Conclusions:
The indication group for transfusion has an impact on the occurrence of severe postoperative morbidity or mortality in children undergoing cardiac surgery.
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