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Perioperative blood transfusion and complications in children undergoing surgery for solid tumors
Dani O Gonzalez1, Jennifer N Cooper1, Erica Mantell2
1Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, Ohio.
Insights
Perioperative blood transfusions (PBT) in children undergoing solid tumor surgery increased the risk of complications, particularly mechanical ventilation and longer hospital stays. Further research is needed to understand these associations.
Area of Science:
- Pediatric Surgery
- Oncology
- Transfusion Medicine
Background:
- Solid tumors are a significant concern in pediatric oncology.
- Perioperative blood transfusion (PBT) is a common intervention in pediatric surgery.
- The association between PBT and postoperative complications in pediatric solid tumor surgery requires further investigation.
Purpose of the Study:
- To evaluate the association between perioperative blood transfusion (PBT) and postoperative complications in pediatric patients undergoing surgery for solid tumors.
- To analyze the impact of PBT on overall complication risk, specific complications like mechanical ventilation, and length of stay.
Main Methods:
- Utilized data from the 2012-2014 National Surgical Quality Improvement Program Pediatric database.
- Included patients aged 0-18 years who underwent surgery (biopsy or resection) for solid tumors.
- Employed propensity score-matched analyses to compare outcomes between children who received PBT and those who did not.
Main Results:
- 27.8% of 961 pediatric solid tumor surgery patients required PBT.
- PBT was associated with increased risk of postoperative mechanical ventilation (OR: 3.78) and overall complications in the tumor resection subgroup (OR: 1.76).
- PBT was consistently linked to a longer postoperative length of stay across all analyses.
Conclusions:
- Perioperative blood transfusion is associated with increased risks of postoperative complications in children undergoing surgery for solid tumors.
- The findings highlight the need for careful consideration of PBT in this vulnerable population.
- Further research should explore strategies to minimize PBT and its associated risks.
Background:
The objective was to assess whether perioperative blood transfusion (PBT) is associated with postoperative complications in children undergoing surgery for a solid tumor.
Methods:
Using 2012-2014 National Surgical Quality Improvement Program Pediatric data, we identified patients aged 0-18 years who underwent surgery (biopsy or resection) for solid tumors. We compared demographic, clinical, and 30-day outcome characteristics between children who did and did not receive a PBT within 72 hours after surgery. Propensity score-matched analyses were used to estimate the effect of PBT on postoperative complications, in the overall cohort, the subgroup undergoing resection, and the subgroup with liver tumors.
Results:
Of 961 patients who underwent surgery for solid tumors, 27.8% required PBT. Patients requiring PBT were more likely to have preoperative risk factors, including ventilator dependence, hematologic disorders, chemotherapy, sepsis, transfusion before surgery, and an American Society of Anesthesiologists class ≥3 (all P ≤ 0.01). In propensity score-matched analyses, PBT was not associated with overall complication risk (odds ratio [OR]: 1.50, P = 0.07) but was associated with an increased risk of postoperative mechanical ventilation (OR: 3.78, P < 0.001). Of the 750 patients undergoing tumor resection, 36.3% required PBT. After propensity matching, PBT was associated with overall postoperative complications (OR: 1.76, P = 0.02). Of 163 patients with liver tumors, 52.8% required PBT. After propensity matching, PBT was not associated with postoperative complications (OR: 2.00, P = 0.09). PBT was associated with a longer postoperative length of stay in all three analyses (all P < 0.01).
Conclusions:
PBT was associated with higher risks for postoperative complications in children undergoing surgery for solid tumors.
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