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Association between preoperative anaemia, transfusion, and outcomes in children undergoing noncardiac surgery
Genevieve McCormack1, David Faraoni2, James A DiNardo2
1State University of New York Upstate Medical University, Syracuse, NY, USA.
Insights
Preoperative anemia and blood transfusions in pediatric noncardiac surgery patients remained stable over 11 years. Both anemia and transfusion independently, and combined, significantly increased 30-day mortality and complications.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Hematology
Background:
- Preoperative anemia and perioperative transfusions are common in pediatric noncardiac surgery.
- Understanding their impact on postoperative outcomes is crucial for patient safety.
Purpose of the Study:
- To evaluate the incidence of preoperative anemia and transfusion in children undergoing noncardiac surgery over an 11-year period.
- To determine the association between preoperative anemia, perioperative transfusion, and 30-day mortality and postoperative complications.
Main Methods:
- Retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program pediatric databases (2012-2023).
- Inclusion of children aged 1-18 years with recorded preoperative hematocrit.
- Categorization into four groups: no anemia/no transfusion, no anemia/transfusion, anemia/no transfusion, anemia/transfusion.
Main Results:
- Preoperative anemia incidence was 25.7% and transfusion rate was 10.4%, remaining stable from 2012-2023.
- 30-day mortality increased significantly across groups, with the highest rate (1.11%) in anemic patients receiving transfusions.
- Children with anemia exposed to perioperative transfusion exhibited the highest incidence of postoperative complications.
Conclusions:
- Preoperative anemia and transfusion rates in pediatric noncardiac surgery are stable.
- Both anemia and transfusion, particularly in combination, are associated with increased 30-day mortality and postoperative complications in children.
Background:
We aimed to evaluate the incidence of preoperative anaemia and transfusion over the last 11 yr and the association between anaemia, transfusion, and postoperative outcomes in children undergoing noncardiac surgery.
Methods:
We identified children 1-18 yr of age who had a preoperative haematocrit recorded between 2012 and 2023 in the American College of Surgeons National Surgical Quality Improvement Program paediatric databases. Patients were included in four groups: patients without anaemia who did not receive a transfusion, patients without anaemia who did receive a transfusion, patients with anaemia who did not receive a transfusion, and patients with anaemia who did receive a transfusion. The outcomes were 30-day mortality and postoperative complications.
Results:
The incidence of preoperative anaemia was 25.7% (n=110 341), and the overall transfusion rate was 10.4% (n=44 808). Between 2012 and 2023, the incidences of preoperative anaemia and transfusion remained stable. The incidence of 30-day mortality increased significantly between children without anaemia who did not receive a transfusion (0.08%), without anaemia who did receive a transfusion (0.30%), with anaemia who did not receive a transfusion (0.27%), or with anaemia who did receive a transfusion (1.11%). The highest incidence of complications was found in children with anaemia exposed to perioperative transfusion.
Conclusions:
The incidence of preoperative anaemia and transfusion in children have remained stable in the last 11 yr. Anaemia, transfusion, and the combination of both increased 30-day mortality and the incidence of postoperative complications.
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