Surgical consultation and intervention during pediatric hematopoietic stem cell transplantation

Area of Science:

• Pediatric surgery
• Hematology
• Oncology

Background:

• Children undergoing hematopoietic stem cell transplant (HSCT) face risks from immune compromise, treatment toxicity, and indwelling catheters.
• Surgical complications may necessitate evaluation by a surgical team during HSCT hospitalization.

Purpose of the Study:

• To define the role and impact of surgical consultations during the primary hospital stay for pediatric HSCT.
• To analyze the reasons for surgical consults and their association with patient outcomes.

Main Methods:

• Retrospective review of consecutive pediatric patients undergoing HSCT between September 2010 and September 2012.
• Analysis of general surgery consultation data, including reasons for consults and interventions performed.
• Comparison of in-hospital mortality and 100-day transplant-related mortality (TRM) between patients with and without surgical consultations.

Main Results:

• General surgery consultations occurred in 33% of HSCT hospitalizations, with 85 total consults across 189 HSCTs in 173 patients.
• The majority of consults (59%) were for central venous line (CVL) issues, followed by abdominal complaints (16%).
• Patients requiring surgical consultation showed significantly higher in-hospital mortality (16% vs. 2%) and 100-day TRM (10% vs. 2%) compared to those without consults.

Conclusions:

• Surgical consultation is common during pediatric HSCT, predominantly for managing complications related to central venous lines.
• The need for surgical consultation is associated with increased in-hospital mortality and 100-day TRM in pediatric HSCT recipients.
• General surgeons and oncologists must be knowledgeable about the surgical issues encountered in this high-risk pediatric HSCT population.