Perioperative Transfusions and Venous Thromboembolism

Area of Science:

• Pediatric Hematology
• Pediatric Critical Care
• Surgical Outcomes

Background:

• The incidence of venous thromboembolism (VTE) in hospitalized children is increasing.
• Red blood cells (RBCs) are implicated in the development of pathological thrombosis.
• The association between perioperative RBC transfusion and postoperative VTE in pediatric patients requires further investigation.

Purpose of the Study:

• To examine the association between perioperative RBC transfusion and postoperative VTE in pediatric patients.
• To stratify the analysis by age groups: neonates, infants, and children.
• To investigate the dose-dependent relationship between RBC transfusion volume and VTE in children.

Main Methods:

• Utilized data from the American College of Surgeons' National Surgical Quality Improvement Project pediatric databases (2012-2017).
• Employed multivariable logistic regression to analyze the association between perioperative RBC transfusion and VTE development within 30 days of surgery.
• Stratified analyses were performed for neonates (≤28 days), infants (>28 days to <1 year), and children (≥1 year).

Main Results:

• Included 20,492 neonates, 79,744 infants, and 382,862 children.
• Postoperative VTE occurred in 0.48% of neonates, 0.2% of infants, and 0.1% of children.
• Perioperative RBC transfusion was significantly associated with increased VTE risk across all age groups (neonates: aOR=4.1; infants: aOR=2.4; children: aOR=2.2).
• In children, higher volumes of RBCs transfused were linked to a dose-dependent increase in VTE risk.

Conclusions:

• Perioperative RBC transfusions are an independent risk factor for postoperative VTE in neonates, infants, and children.
• The findings suggest a dose-dependent relationship between RBC transfusion volume and VTE risk in children.
• Further prospective studies are needed to validate these findings and inform evidence-based transfusion guidelines in pediatric surgery.