Perioperative Outcomes and Transfusion Practices in Neonates Undergoing Sacrococcygeal Teratoma Resection: A Single...

Sacrococcygeal teratomas (SCT), although rare, are the most common teratomas found in neonates. Anesthetic management of neonates undergoing SCT resection surgery is challenging, given the risk of massive hemorrhage and high mortality rate.

The primary aim of this single center retrospective study was to analyze neonates undergoing SCT resection over the last decade and report on perioperative outcomes, including blood product transfusion practices. The secondary aim was to describe patient and tumor characteristics that might place neonates undergoing SCT resection surgery at elevated risk for morbidity and mortality.

Retrospective chart review of neonates who underwent sacrococcygeal teratoma resection at Boston Children's Hospital between January 2012 and April 2024. Demographic data, tumor characteristics, transfusion data, perioperative respiratory and hemodynamic data, and 30-day outcomes were collected. Descriptive statistics for patient and tumor characteristics are reported. Univariate analyses using Fisher's exact test and the Wilcoxon rank sum test were used for analysis of transfusion data and clinically significant postoperative events.

Seventeen patients were identified. The median age at the time of surgery was day of life 4 with a median weight of 3.3 kg. Thirty-nine percent of neonates experienced a clinically significant postoperative event within 30 days of surgery, defined as a composite outcome event. One patient died within 30 days of surgery. Fifty-nine percent of neonates received an intraoperative blood transfusion. The median transfusion volume of RBCs was 24.8 mL/kg (0, 43). Those transfused had a larger median tumor volume [947.3 cm³ (interquartile range: 354.2, 2048)] and tumor volume-to-weight ratio [0.31 (0.10, 0.77)] compared to those who were not transfused [48.6 cm³ (24.2, 367.5)] and [0.02 (0.01, 0.07)] respectively. The median duration of anesthesia in transfused patients was 7.8 h (6.4, 9.2) versus 5.8 h (3.7, 6.7) in patients not transfused. Although more neonates with non-cystic tumors got transfused (70% vs. 30%), there was no statistically significant difference in median volume of red blood cells transfused intraoperatively for cystic [28.1 mL/kg (0, 40)] versus non-cystic tumors [24.8 mL/kg (0, 60)].

Neonates undergoing SCT surgery had a high rate of blood transfusion (59%), replacing on average over a quarter of their blood volume, and a high composite adverse outcome rate (39%). Predictors of blood product transfusion include immature tumors, gestational age less than 37 weeks, larger median tumor volume, greater tumor volume-to-weight ratio, higher intraoperative estimated blood loss, and longer time under anesthesia. Predictors of clinically significant postoperative events within 30 days of surgery include Altman type 2 tumors, gestational age less than 37 weeks, and longer anesthesia times.