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Predictors of transfusion outcomes in pediatric complex cranial vault reconstruction: a multicentre observational
Patrick G Fernandez1, Brad M Taicher2, Susan M Goobie3
1Section of Pediatric Anesthesiology, Department of Anesthesiology, Children's Hospital Colorado, University of Colorado, 13123 E. 16th Ave, Box 090, Aurora, CO, USA. patrick.fernandez@childrenscolorado.org.
Insights
Minimizing blood transfusions during pediatric complex cranial vault reconstruction (CCVR) is crucial. Key factors influencing transfusion needs include patient age, surgical duration, and specific interventions like antifibrinolytic use and cell saver technology.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Hematology
Background:
- Pediatric patients undergoing complex cranial vault reconstruction (CCVR) face significant risks of perioperative blood loss and subsequent transfusion.
- Minimizing allogeneic blood product transfusion is a critical goal due to associated risks and costs.
- Understanding patient and surgical variables impacting transfusion in this population is essential.
Purpose of the Study:
- To investigate the relationships between demographic and perioperative variables and blood product transfusion outcomes in pediatric CCVR.
- To identify factors associated with intraoperative red blood cell-containing product (RBC-CP) transfusion, overall blood donor exposures, and transfusion-free hospitalization.
Main Methods:
- Data from 1,814 pediatric CCVR cases were analyzed from the multicentre Pediatric Surgery Perioperative Registry (June 2012–September 2016).
- Univariable and multivariable analyses examined patient, procedure, and blood conservation variables.
- Outcomes assessed included intraoperative RBC-CP transfusion, total perioperative blood donor exposures, and transfusion-free hospitalization.
Main Results:
- Age and surgical duration were significantly associated with all three transfusion-related outcomes.
- Lower American Society of Anesthesiologists (ASA) physical status and antifibrinolytic use predicted reduced RBC-CP transfusion.
- Increased body weight, higher preoperative hematocrit, and use of intraoperative cell saver and transfusion protocols were linked to transfusion-free hospitalization.
Conclusions:
- Clinical factors associated with increased allogeneic blood product transfusion in pediatric CCVR include younger age (≤ 24 months), higher ASA status (≥ III), preoperative anemia, and prolonged surgical duration.
- Lack of antifibrinolytic use, cell saver use, and established transfusion protocols also correlate with higher transfusion rates.
- Identifying these predictive factors can guide strategies to minimize blood product use in pediatric CCVR.
Purpose:
Pediatric patients undergoing complex cranial vault reconstruction (CCVR) are at risk of significant perioperative blood loss requiring blood product transfusion. Minimizing allogeneic blood product transfusion is an important goal because of the associated risks and cost. The impact of patient and surgical variables on transfusion is unknown in this population. Our primary aim was to examine relationships between demographic and perioperative variables and blood product transfusion outcomes in CCVR.
Methods:
The multicentre Pediatric Surgery Perioperative Registry was checked for children undergoing CCVR between June 2012 and September 2016. Univariable and multivariable analyses were performed examining patient, procedure, and blood conservation variables and their relationship to three outcomes: intraoperative red blood cell-containing product (RBC-CP) transfusion, total perioperative blood donor exposures, and transfusion-free hospitalization.
Results:
The registry search returned data from 1,814 cases. Age and surgical duration were the only variables significantly associated with all three outcomes studied. Predictors of reduced RBC-CP transfusion included lower American Society of Anesthesiologists (ASA) physical status and antifibrinolytic administration. Total cranial vault reconstruction, intraoperative vasoactive infusion, and presence of a tracheostomy predicted increased donor exposures. Increased body weight, higher preoperative hematocrit, and utilization of intraoperative cell saver and transfusion protocols were associated with transfusion-free hospitalization.
Conclusion:
Clinical factors associated with increased allogeneic blood product transfusion in pediatric CCVR include: age ≤ 24 months, ASA status ≥ III, preoperative anemia, prolonged surgical duration, lack of intraoperative antifibrinolytic use, lack of intraoperative cell saver use, and the lack of transfusion protocols.
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