Perioperative Blood Transfusion and Infectious Complications Among Pediatric Patients with Cancer

Area of Science:

• Pediatric Oncology
• Surgical Oncology
• Transfusion Medicine

Background:

• Perioperative blood transfusion is a known risk factor for postoperative infections in adult cancer patients.
• The association between perioperative blood transfusion and infectious complications in pediatric cancer patients was previously unclear.

Purpose of the Study:

• To investigate the association between perioperative blood transfusion and postoperative infectious complications in pediatric patients with cancer.
• To determine if perioperative blood transfusion is an independent risk factor for adverse outcomes in this population.

Main Methods:

• Retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program Pediatric (NSQIP-P) database (2015-2019).
• Inclusion of pediatric patients with active cancer undergoing surgery.
• Statistical analysis using chi-square, Fisher's exact tests, and multivariate logistic regression.

Main Results:

• 14,973 pediatric cancer patients were analyzed; 17.4% received perioperative blood transfusion (PBT).
• PBT was associated with significantly higher rates of multiple postoperative infectious complications (surgical-site infection, pneumonia, UTI, C. difficile, CLABSI, sepsis) and increased 30-day mortality.
• Multivariate analysis confirmed PBT as an independent risk factor for infectious complications (OR 1.9) and death (OR 1.8).

Conclusions:

• Pediatric cancer patients undergoing surgery who receive PBT face elevated risks of postoperative infections and 30-day mortality.
• Given baseline immunosuppression in this population, infections post-transfusion can be particularly severe.
• Judicious evaluation of transfusion risks and benefits is essential for pediatric cancer patients.