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Reducing Allogenic Blood Transfusion in Pediatric Scoliosis Surgery:: Reporting 15 Years of a Multidisciplinary,
Alastair G Dick1, Richard J Pinder2, Shirley A Lyle1
1Guy's & St Thomas' NHS Foundation Trust, London, UK.
Insights
A new care pathway significantly reduced blood transfusions in pediatric scoliosis surgery. This multidisciplinary approach, including preoperative optimization and tranexamic acid, lowered transfusion rates and volumes over 15 years.
Area of Science:
- Pediatric Orthopedic Surgery
- Transfusion Medicine
- Patient Blood Management
Background:
- Scoliosis correction surgery in children historically involves significant blood loss and transfusion rates.
- Reducing allogeneic blood transfusions is crucial for patient safety and resource management.
Purpose of the Study:
- To evaluate the effectiveness of a comprehensive care pathway designed to minimize blood transfusions in pediatric scoliosis surgery.
- To assess the impact of preoperative hemoglobin optimization, intraoperative cell salvage, tranexamic acid, and transfusion guidelines.
Main Methods:
- Retrospective review of prospectively collected spinal surgery and transfusion databases.
- Analysis of 1039 pediatric scoliosis correction cases between 2001 and 2015.
- Multivariate logistic regression to identify predictors of transfusion.
Main Results:
- Overall transfusion rates decreased from 89.2% (2001-2003) to 20.1% (2013-2015).
- Transfused blood volume per patient also significantly reduced over the study period.
- Neuromuscular diagnoses and combined anterior/posterior approaches were associated with higher transfusion probability.
Conclusions:
- A multifaceted, multidisciplinary care pathway can dramatically and sustainably reduce blood transfusions in pediatric scoliosis surgery.
- The demonstrated efficacy supports the adoption of such pathways to mitigate transfusion risks.
- This approach enhances patient safety and optimizes resource utilization in pediatric orthopedic surgery.
Study Design:
Retrospective review of prospectively collected spinal surgery and transfusion databases.
Objectives:
To evaluate the efficacy of a care pathway developed at our institution since 2003 with a focus on reducing the need for blood transfusions in children undergoing scoliosis correction surgery. The care pathway includes nurse-led clinics facilitating preoperative hemoglobin optimization, intraoperative cell salvage, the use of tranexamic acid, and a transfusion criteria awareness program.
Methods:
Retrospective review of our institution's prospectively recorded spinal surgery and transfusion databases including all cases of scoliosis surgery in patients 18 years and younger between 2001 and 2015.
Results:
A total of 1039 procedures were included in the analysis. Overall, 24.4% of patients received a transfusion. The proportion of patients transfused was 89.2% in 2001-2003, 39.6% in 2004-2006, 16.5% in 2007-2009, 15.6% in 2010-2012, and 20.1% in 2013-2015. The volume of blood products transfused in those undergoing transfusion was 9.1 units in 2001-2003, 4.8 units in 2004-2006, 5.0 units in 2007-2009, 2.3 units in 2010-2012, and 2.1 units in 2013-2015. A multivariate logistic regression demonstrated adjusted odds ratios for the probability of receiving any transfusion of 5.45 (95% confidence interval 3.62-8.11) for patients with neuromuscular diagnoses and 11.17 (5.02-24.86) for those undergoing combined anterior and posterior surgical approach.
Conclusions:
We have demonstrated over a 15-year period that the introduction of a multifaceted, multidisciplinary pathway can dramatically and sustainably reduce the need for blood transfusions and their attendant risks in pediatric scoliosis surgery. This data lends weight to the adoption of such a care pathway in pediatric scoliosis surgery.
