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Allogeneic Red Blood Cell Transfusion and Infectious Complications Following Pediatric Spinal Fusion: NSQIP-P
Lisa Eisler1, Fthimnir Hassan2, Lawrence G Lenke2
1Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, Columbia University, New York, NY.
Insights
Allogeneic red blood cell transfusion (ARBT) during pediatric spinal fusion surgery is linked to higher risks of postoperative infections like pneumonia and sepsis. The risk of infection increases with the volume of blood transfused, highlighting the need to minimize transfusions.
Area of Science:
- Pediatric Surgery
- Transfusion Medicine
- Infectious Disease
Background:
- Pediatric spinal fusion surgery often involves significant bleeding, leading to perioperative anemia.
- Allogeneic red blood cell transfusion (ARBT) is commonly used to treat anemia but may increase infection risk.
- Existing studies on ARBT and infection in pediatric spinal fusion patients show conflicting results.
Purpose of the Study:
- To investigate the association between perioperative ARBT and postoperative infectious complications in children undergoing spinal fusion.
- To determine if ARBT independently predicts specific infections (pneumonia, UTI, sepsis) or overall infection risk.
- To examine the dose-response relationship between transfusion volume and infection risk.
Main Methods:
- Retrospective analysis of the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database (2016-2019).
- Inclusion of patients under 18 who underwent spinal fusion.
- Multivariable logistic regression to assess the association between ARBT and postoperative infections, adjusting for patient and procedural factors.
Main Results:
- Of 19,159 patients, 3.7% experienced postoperative infections.
- ARBT was independently associated with increased risks of pneumonia (aOR=1.93), UTI (aOR=1.80), and sepsis (aOR=1.58).
- Overall infection risk was higher with ARBT (aOR=1.40), showing a dose-response relationship with transfusion volume.
Conclusions:
- Perioperative ARBT in pediatric spinal fusion is significantly associated with increased risks of pneumonia, UTI, and sepsis.
- Higher transfusion volumes correlate with a greater risk of postoperative infection.
- Minimizing perioperative anemia and ARBT is crucial for improving outcomes in pediatric spinal fusion patients.
Abstract:
Substantial bleeding occurs during spinal fusion surgery in the pediatric population, and many patients receive allogeneic red blood cell transfusion (ARBT) for the treatment of resulting perioperative anemia. ARBT is thought to increase vulnerability to postoperative infections following major surgical procedures, but studies of this relationship in children undergoing spinal fusion have yielded conflicting results.
Methods:
Patients who underwent spinal fusion before the age of 18 years were identified from the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) 2016 to 2019 databases, along with patient and procedure-specific characteristics, transfusion events and volumes, and postoperative infectious complications such as wound-related infection, pneumonia, urinary tract infection (UTI), and sepsis. Multivariable logistic regression analyses provided adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for the association between ARBT and each infection outcome and the overall risk of infection.
Results:
Among 19,159 patients studied, 714 (3.7%) developed a total of 931 episodes of postoperative infection. In multivariable logistic regression analyses, perioperative ARBT was independently associated with postoperative pneumonia (aOR = 1.93, 95% CI = 1.40 to 2.68), UTI (aOR = 1.80, 95% CI = 1.19 to 2.73), sepsis (aOR = 1.58, 95% CI = 1.10 to 2.28), and the overall risk of infection (aOR = 1.40, 95% CI = 1.20 to 1.64). The risk of any postoperative infection increased in a dose-response fashion with transfusion volume.
Conclusions:
ARBT in pediatric spinal fusion is associated with significantly increased risks of postoperative pneumonia, UTI, and sepsis. The overall risk of postoperative infection increases with the volume transfused. Enhanced efforts to minimize perioperative anemia and ARBT should be considered as a means of improving patient outcomes.
Level Of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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