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Published on: October 16, 2013
Predictive factors for homologous transfusion during paediatric scoliosis surgery
Claire Dupuis1, Daphné Michelet1, Julie Hilly1
1Department of Anaesthesia and Intensive care, Robert-Debré University Hospital, Paris, France; Paris Diderot University, Paris VII, PRES Paris Sorbonne Cité, Paris, France.
Insights
Optimizing nutritional status and considering surgery duration may help prevent blood transfusions in pediatric scoliosis surgery. Identifying children with weight below the 3rd percentile and neuromuscular scoliosis is key for reducing transfusion risks.
Area of Science:
- Pediatric Orthopedic Surgery
- Transfusion Medicine
- Scoliosis Research
Background:
- Paediatric spinal surgery often employs blood-saving strategies like recombinant erythropoietin (rEPO) and antifibrinolytic therapy (AFT).
- Additional factors influencing the risk of blood transfusion require investigation.
- Understanding these factors can optimize patient management and reduce transfusion needs.
Purpose of the Study:
- To identify predictors of homologous red cell transfusion in children undergoing scoliosis surgery.
- To analyze factors associated with perioperative transfusion probability.
- To enhance strategies for blood conservation in pediatric spinal procedures.
Main Methods:
- Prospective study of 147 children undergoing scoliosis surgery.
- Multivariate logistic regression analysis to identify transfusion predictors.
- Analysis included: weight percentile, scoliosis type, surgery duration, and other clinical variables.
Main Results:
- Weight less than the 3rd percentile (W<3P), neuromuscular scoliosis, and surgery duration over 255 minutes were independent predictors of increased transfusion risk.
- The predictive model demonstrated high accuracy (92.3%) and a significant area under the ROC curve (0.9).
- Sensitivity analysis confirmed results even when excluding patients who received EPO.
Conclusions:
- Optimizing nutritional status, particularly in children with W<3P, may be a crucial factor in preventing allogeneic blood transfusions.
- Shorter surgical duration and avoiding neuromuscular scoliosis indications could also reduce transfusion requirements.
- Further research into nutritional optimization is warranted to refine blood conservation strategies.
Introduction:
Blood saving strategies during paediatric spinal surgery often include recombinant erythropoietin (rEPO) and antifibrinolytic therapy (AFT). The goal of this study was to investigate additional preventive factors involved in the risk of blood transfusion.
Methods:
This prospective study was designed with the aim of identifying factors associated with the perioperative (defined as the intraoperative and the first postoperative day) probability of homologous red cell transfusion during scoliosis surgery in children operated during a one year period in our institution. The predictors analysed were: age, weight less than the 3rd percentile (W<3P), indication for spinal surgery (idiopathic or neuromuscular), Cobb's angle, ASA status, preoperative haemoglobin, number of levels fused, duration of surgery, intraoperative fluid intakes, sacral fusion and thoracoplasty. Statistical analyses were performed using a multivariate logistic regression model.
Results:
One hundred and forty-seven patients were included in the analysis. Multivariate analysis found the following variables to be independent predictors for an increased risk of homologous blood transfusion: W<3P, neuromuscular scoliosis and duration of surgery > 255 minutes. ROC analysis for the latter model found an area under the curve of 0.9 (95% confidence interval: 0.8-0.97). The accuracy of the model was 92.3% (97.4% for non-transfusion and 69.2% for transfusion). Multivariate sensitivity analysis excluding patients with no preoperative administration of EPO found similar results.
Conclusion:
The current results indicate that optimising nutritional status might prevent allogenic blood transfusion and requires further investigation.
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