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Rethinking transfusion timing: Evaluating preoperative transfusion morbidity using a national pediatric database

Matthew T Parrish1, Katie Bews2, Stephanie F Polites3

  • 1Department of Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.

American Journal of Surgery
|November 29, 2025
PubMed

Insights

Preoperative transfusion (PBT) before pediatric surgery is linked to fewer infections than postoperative transfusion (BT). This study found PBT associated with lower rates of postoperative infection and surgical site infection in pediatric patients.

Area of Science:

  • Pediatric Surgery
  • Transfusion Medicine
  • Patient Outcomes

Background:

  • Postoperative transfusion (BT) in pediatric patients correlates with increased morbidity.
  • The effect of preoperative transfusion (PBT) on pediatric surgical outcomes remains unclear.

Purpose of the Study:

  • To investigate the association between PBT and postoperative infection rates compared to BT in pediatric general surgery.
  • To test the hypothesis that PBT is associated with lower morbidity than BT.

Main Methods:

  • Utilized the 2012-2022 NSQIP-P database for pediatric general surgery patients.
  • Excluded patients with preoperative hematocrit below 21%.
  • Employed propensity-score matching to compare PBT and BT groups, analyzing postoperative infection (PI) and surgical site infection (SSI) rates via logistic regression.

Main Results:

  • A cohort of 15,401 pediatric patients was analyzed, with 30% receiving PBT and 70% receiving BT.
  • After propensity-score matching, 3439 PBT patients were compared to 3439 BT patients.
  • PBT demonstrated significantly lower rates of PI (8% vs. 10%) and SSI (5% vs. 8%) compared to BT.

Conclusions:

  • Preoperative transfusion (PBT) is associated with reduced odds of postoperative infections in pediatric general surgery patients.
  • The findings suggest PBT may be a safer transfusion timing strategy compared to BT for this population.
Abstract

Keywords:
BleedingNSQIP-PPreoperative transfusionSurgical site infection

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