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Updated: Sep 1, 2025
A Precision Medicine Tool for Measurement and Monitoring of Hemoglobin S in Sickle Cell Disease Patients Receiving Transfusion Therapy
Preoperative Transfusion and Surgical Outcomes for Children with Sickle Cell Disease
Pooja S Salvi1, Daniel G Solomon, Robert A Cowles
1From the Division of Pediatric Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT.
Insights
Preoperative red blood cell transfusion did not improve outcomes for children with sickle cell disease undergoing abdominal surgery. Current guidelines may lead to unnecessary transfusions, highlighting the need for further research.
Area of Science:
- Pediatric Surgery
- Hematology
- Transfusion Medicine
Background:
- Current guidelines for preoperative transfusion in sickle cell disease (SCD) are based on limited evidence.
- The specific benefits of preoperative transfusion in pediatric SCD patients are not well-established.
Purpose of the Study:
- To evaluate the association between preoperative red blood cell (RBC) transfusion and sickle cell crisis and surgical complications in children with SCD undergoing abdominal operations.
Main Methods:
- Utilized the NSQIP-Pediatrics database (2013-2019) for patients with SCD undergoing cholecystectomy, splenectomy, or appendectomy.
- Employed propensity score matching to compare outcomes between transfused and non-transfused cohorts.
- Primary outcome: 30-day readmission for sickle cell crisis; Secondary outcomes: 30-day surgical complications and hospital length of stay.
Main Results:
- In a matched cohort of 278 pediatric SCD patients, no significant difference was found in 30-day readmission for sickle cell crisis (5.8% vs. 7.2%) or surgical complications (10.8% vs. 9.4%) between transfused and non-transfused groups.
- Subgroup analyses based on hematocrit levels, ASA classification, wound class, and operation type did not reveal altered risks associated with preoperative transfusion.
Conclusions:
- Preoperative transfusion in children with SCD undergoing semi-elective abdominal surgery is not associated with improved outcomes.
- Further prospective studies are needed to refine guidelines and reduce potentially unnecessary perioperative transfusions in this population.
Background:
Current guidelines recommending preoperative transfusion to a hemoglobin level of 9 to 10 g/dL for patients with sickle cell disease (SCD) are based on imperfect evidence. The benefit of preoperative transfusion in children specifically is not known. This study aimed to evaluate whether preoperative RBC transfusion is associated with different rates of sickle cell crisis and surgical complications, compared with no preoperative transfusion, among children with SCD undergoing common abdominal operations.
Study Design:
The NSQIP-Pediatrics database (2013 to 2019) was queried. Patients who underwent cholecystectomy, splenectomy, or appendectomy with a preoperative Hct level of less than 30% were included. The primary outcome was 30-day readmission for sickle cell crisis. Secondary outcomes were 30-day surgical complications and hospital length of stay. Propensity score matching methods were used to obtain two statistically similar cohorts of patients comprised of those who were preoperatively transfused and those who were not.
Results:
Among 357 SCD patients, 200 (56%) received preoperative transfusion. In the matched cohort of 278 patients (139 per group), there was no statistically significant difference in 30-day readmission for sickle cell crisis in the transfused and non-transfused groups (5.8% vs 7.2%, p = 0.80). The rate of 30-day surgical complications did not differ between matched groups (10.8% vs 9.4%, p = 0.84). Subgroups defined by presenting Hct levels of 27.3% or greater or less than 27.3%, American Society of Anesthesiologists classification, wound class, and index operation were not associated with an altered risk of sickle cell crisis or surgical complications after preoperative transfusion compared with no transfusion.
Conclusions:
Preoperative transfusion for children with SCD undergoing semi-elective abdominal operations was not associated with improved outcomes. Prospective investigation is warranted to strengthen guidelines and minimize unnecessary perioperative transfusions in this population.
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