Transfusion and outcomes in paediatric surgical patients: an 11-year retrospective North American cohort study

Paediatric perioperative blood transfusion trends remain poorly described. The purpose of this study was to determine the incidence and associated outcomes of red blood cell (RBC) transfusion in paediatric surgical patients over a recent decade in North America.

This retrospective cohort study utilised data from the American College of Surgeons National Surgical Quality Improvement Program paediatric databases spanning a decade. Patients aged 0-18 yr who underwent noncardiac surgery were included. Patient characteristics and outcome variables were compared between patients exposed to a transfusion and those who were not using the Wilcoxon rank sum test for continuous variables and χ² test for categorical variables. The association between RBC transfusion and outcomes was analysed by multivariable logistic regression models. The primary aim was to describe the incidence of RBC transfusion for paediatric surgery over an 11-yr period. The secondary aim was to assess the relationship between RBC transfusion and adverse outcomes according to age groups and volumes transfused.

Among the 1 303 500 paediatric patients included during 2012-23, 82 742 (6.3%) received RBC transfusion in the perioperative period (defined as intraoperatively up to 72 h after surgery). There was an upward trajectory in paediatric transfusions over the 11-yr period, ranging from 4.7% (2016) to 7% (2021). The 30-day mortality rate in those transfused was 2.4% compared with 0.2% in those not transfused (adjusted P-value <0.001). Those transfused experienced more complications (adjusted P-value <0.001 for all comparisons) which was distinct for higher volumes given. Neonates and older children (≥12 yr old) had higher transfusion exposure at 13.3% and 9.6%, respectively. Neonates and children had higher associated rates of 30-day mortality (14.9% for neonates, 1.4% for children aged 1-6 yr) and adverse outcomes. Comparing death at 30 days with and without blood transfusion, there was an independent association between transfusion and 30-day mortality (adjusted odds ratio 2.11, 95% confidence interval 1.95-2.27).

We describe the incidence of RBC transfusion and associated mortality over a decade for paediatric patients undergoing noncardiac surgery. Ongoing vigilance in perioperative transfusion management and tailored interventions to mitigate associated risks and optimise perioperative outcomes are needed in bleeding and anaemic paediatric surgical patients.