Transfusions in Children's Surgery: Characterization and Development of a Model for Benchmarking

Area of Science:

• Pediatric Surgery
• Transfusion Medicine
• Health Services Research

Background:

• Perioperative blood transfusions in children are linked to increased morbidity and potential overuse.
• Identifying high-transfusion procedures is crucial for optimizing resource allocation and patient outcomes.

Purpose of the Study:

• To identify surgical procedures most frequently associated with red blood cell (RBC) transfusions in pediatric patients.
• To develop risk-adjusted models for benchmarking transfusion practices across institutions.

Main Methods:

• Utilized data from the 2012-2015 National Surgical Quality Improvement Program-Pediatric.
• Grouped Current Procedural Terminology (CPT) codes to identify transfusion-associated procedures.
• Developed logistic regression models for two pediatric age groups (0-3 months and 3 months to 18 years).

Main Results:

• 5.8% of 369,176 pediatric cases involved perioperative transfusions.
• Spinal deformity arthrodesis (44.5%) and craniosynostosis repair (8.7%) were the most common transfusion-associated procedures.
• Risk-adjusted models demonstrated strong predictive performance (AUC 0.866 and 0.911).

Conclusions:

• Pediatric surgical transfusions are concentrated in a limited number of procedures.
• Findings enable targeted blood optimization efforts on high-transfusion surgeries.
• Developed risk-adjusted models can facilitate hospital benchmarking of transfusion rates.