Allogeneic Transfusion-related Adverse Events in Pediatric Idiopathic Scoliosis Surgery

Pediatric spinal deformity surgery can involve significant perioperative blood loss, and allogeneic blood transfusion has been linked to an increased risk of adverse events. This study aimed to quantify adverse events associated with allogeneic blood transfusion in pediatric idiopathic scoliosis surgery.

Retrospective observational cohort study.

The National Surgical Quality Improvement Program (NSQIP) Pediatric database (2016-2022) was queried. Patients <18 years undergoing posterior arthrodesis with 7 or more surgical levels for idiopathic scoliosis were included. The primary outcome was a composite 30-day adverse event outcome. Chi-square tests were used to compare the rates of adverse events associated with allogeneic blood transfusion. A multivariable logistic regression analysis was performed to assess the association between allogeneic blood transfusion and the occurrence of adverse events.

A total of 23,106 patients were included in this study, of which 12.3% received allogeneic transfusion. The rate of the composite 30-day adverse event outcome was 1.1%. Patients that received allogeneic transfusion had a higher rate of 30-day adverse event (2.5% vs 0.9%; X² ​= ​62.5, P ​< ​.001). Allogeneic transfusion was associated with a higher rate of renal failure, cardiac arrest, venous thromboembolism, deep wound infection/dehiscence, sepsis/septic shock, pneumonia, and unplanned reintubation. In a multivariable logistic regression analysis, allogeneic transfusion was associated with higher odds of the composite 30-day adverse event outcome (odds ratio [OR]: 2.09, P ​< ​.001).

In this large national pediatric registry cohort, allogeneic transfusion was associated with higher odds of 30-day adverse events after posterior spinal fusion for idiopathic scoliosis. Further prospective and center-level studies are needed to clarify transfusion thresholds, blood management strategies, and potential contributors to adverse outcomes.

(1)In 23,106 pediatric idiopathic scoliosis patients from the American College of Surgeons National Surgical Quality Improvement Program, 12.3% received allogeneic transfusion and the overall 30-day composite adverse event rate was 1.1%.(2)Patients who received allogeneic transfusion had a significantly higher rate of composite 30-day adverse events compared to those who did not (2.5% vs 0.9%, P ​< ​.001).(3)Allogeneic transfusion was associated with higher rates of specific complications, including renal failure, cardiac arrest, venous thromboembolism, unplanned reintubation, deep wound infection/dehiscence, sepsis/septic shock, pneumonia, and 30-day mortality.(4)On multivariable logistic regression, allogeneic transfusion independently increased the odds of composite adverse events (OR: 2.09, 95% CI: 1.37-3.19, P ​< ​.001).

Level III.