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Perioperative Blood Transfusion and Infectious Complications Among Pediatric Patients with Cancer
Elizabeth D Cochran1, Jillian C Jacobson1, Arti Machchhar1
1Department of Pediatric Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
Insights
Perioperative blood transfusion increases infectious complications and mortality in pediatric cancer surgery patients. Careful consideration of transfusion risks versus benefits is crucial for this vulnerable population.
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.
Abstract:
Background: Perioperative blood transfusion has been identified as a risk factor for postoperative infectious complications in adult patients with cancer. This study aimed to determine whether this association also exists in pediatric patients with cancer. Methods: A retrospective analysis was performed using the American College of Surgeons National Surgical Quality Improvement Program Pediatric (NSQIP-P) database. Pediatric patients with an active cancer diagnosis at the time of surgical intervention from 2015 to 2019 were reviewed. Statistical analysis was performed using Pearson chi-square and Fisher's exact tests as well as multiple logistic regression. Result: In total, 14,973 pediatric patients who underwent a surgical procedure and had an active cancer diagnosis at the time of operation were identified. Of these, 2602 patients (17.4%) received a perioperative blood transfusion (PBT). Patients who received a PBT experienced higher rates of postoperative infectious complications, including surgical-site infection (p < 0.0001), pneumonia (p < 0.0001), urinary tract infection (p < 0.0001), C. difficile infection (p < 0.0001), central-line-associated bloodstream infection (p < 0.0001), and sepsis (p < 0.0001). Patients who received a PBT also had increased 30-day mortality compared with those who did not receive a PBT (p < 0.0001). On multivariate analysis, PBT remained an independent risk factor for postoperative infectious complications (OR 1.9, 95% CI 1.61-2.32) and death (OR 1.8, 95% CI 1.23-2.71). Conclusions: Pediatric patients with cancer who undergo surgery and receive a blood transfusion in the perioperative period have increased 30-day mortality and are at increased risk for postoperative infectious complications. Considering that these patients are often immunosuppressed at baseline, infections can be particularly devastating in this population. As such, it is important to carefully consider the risks and benefits of PBT prior to transfusion.
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