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Reducing Transfusions in Neuromuscular Spinal Fusion: A National Surgical Quality Improvement Program-Pediatrics
Holden Archer1, Venessa L Pinto2, Farrah Russell3
1Department of Pediatric Orthopaedic Surgery, Baylor College of Medicine, Houston, TX, USA.
Summary
Implementing a new perioperative pathway significantly reduced blood transfusions for pediatric neuromuscular scoliosis patients. This initiative improved patient safety by minimizing transfusion risks and associated complications.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Quality Improvement
Background:
- Pediatric spinal fusion, especially for neuromuscular scoliosis, carries a high risk of significant blood loss and frequent transfusions.
- Blood transfusions in pediatric patients are associated with risks such as transfusion reactions, alloimmunization, volume overload, and infection.
Purpose of the Study:
- To design and implement a perioperative pathway aimed at reducing transfusion volume in pediatric patients undergoing spinal fusion for neuromuscular scoliosis.
- The primary goal was to reduce transfusion volume to less than 25 mL/kg, with a secondary goal of decreasing overall transfusion volume.
Main Methods:
- A multidisciplinary team developed and implemented a standardized perioperative pathway covering preoperative, intraoperative, and postoperative phases.
- Key interventions included preoperative optimization, intraoperative blood conservation techniques (e.g., tranexamic acid, cell salvage), and standardized postoperative transfusion protocols.
Main Results:
- The median transfusion volume decreased from 9.3 mL/kg (baseline) to 5.1 mL/kg post-implementation.
- The proportion of patients exceeding the 25 mL/kg transfusion threshold decreased significantly, with the institution no longer being an outlier in the ACS NSQIP-P registry.
Conclusions:
- A multidisciplinary, evidence-based perioperative pathway can safely reduce transfusion exposure in pediatric patients with neuromuscular scoliosis undergoing spinal fusion.
- Standardized care across the perioperative period, including patient optimization and conservative transfusion strategies, is effective in minimizing transfusion requirements.
