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Evaluation for Perioperative Blood Transfusion during Major Abdominal Procedures in a Pediatric Population: A
Hong Zhou1, Jiaming Lan1, Hai Zhu1
1Department of Pediatric General Surgery, Children's Hospital, Chongqing Medical University, Chongqing, China.
Insights
Inappropriate and overtransfusion of blood products occurred frequently in pediatric patients undergoing major abdominal surgery, particularly in younger patients and those having hepatic resections. Further research is needed to confirm these findings.
Area of Science:
- Pediatric Surgery
- Transfusion Medicine
- Surgical Outcomes
Background:
- Perioperative blood transfusion is common in pediatric major abdominal surgery.
- Understanding factors influencing transfusion practices is crucial for optimizing patient care and resource utilization.
Purpose of the Study:
- To investigate modifiable factors affecting perioperative blood transfusion in pediatric patients undergoing major abdominal procedures.
- To analyze the incidence and characteristics of inappropriate and overtransfusion.
Main Methods:
- Retrospective review of 1,506 pediatric patients undergoing major abdominal surgery (2008-2018).
- Analysis of clinical data on blood administration, including transfusion triggers and targets.
- Application of criteria for inappropriate transfusion (Hb trigger > 8.0 g/dL) and overtransfusion (target > 10.0 g/dL or > 2 g/dL difference).
Main Results:
- Intraoperative transfusion was administered to 31.1% of patients.
- 45.3% of intraoperative transfusions were deemed inappropriate, and 28.8% were classified as overtransfusion.
- Inappropriate transfusions and overtransfusion were associated with younger age and specific procedures like hepatic or intestinal resection.
Conclusions:
- Overtransfusion is prevalent in pediatric hepatic resections and younger patients.
- While associations were found, multivariate analysis did not link inappropriate or overtransfusion to perioperative complications in this cohort.
- A prospective randomized trial is recommended to definitively establish the impact of these transfusion practices.
Objectives:
The purpose of this study was to examine modifiable factors and their impact on perioperative blood transfusion for pediatric patients with major abdominal procedures.
Methods:
This is a retrospective review of 1,506 patients who underwent major abdominal surgical procedures in a tertiary medical center from January 2008 to June 2018. Clinical data about blood administration including triggers and targets for intra- or postoperative transfusion were collected and analyzed. The inappropriate transfusion (transfusion > 8.0 g/dL of hemoglobin [Hb] trigger) and overtrans-fusion criteria (target transfusion > 10.0 g/dL or > 2 g/dL of target minus trigger level) were applied to examine the intraoperative factors with the intraoperative transfusion practice. Perioperative morbidity was further assessed based on the inappropriate transfusion and overtransfusion status.
Results:
Intraoperative transfusion was used in 468 (31.1%) of the 1,506 patients included in the study. Among them, 212 (45.3%) intraoperative transfusion episodes were classified as inappropriate, and 135 cases (28.8%) were confirmed as overtransfusion. On univariate analysis, inappropriate transfusions were observed more commonly among patients with younger age (p < 0.001) and who underwent hepatic resection (p < 0.001) or intestinal resection (p < 0.001). Overtransfusion was also associated with elevated trigger of 8.0 g/dL Hb (p = 0.006) and younger age (p = 0.003). No perioperative complications were associated with inappropriate transfusions and overtransfusion under multivariate analysis.
Conclusions:
Overtransfusion was common in hepatic resection and younger age, but to definitely prove this hypothesis, a prospective randomized trial needs to be performed.
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