Patrick G Fernandez1, Brad M Taicher2, Susan M Goobie3, Meera Gangadharan4, H Mayumi Homi2, Jane A Kugler5, Rochelle Skitt6, Lingyu Cai7, Marcia Polansky7, Paul A Stricker8. 1. Section of Pediatric Anesthesiology, Department of Anesthesiology, Children's Hospital Colorado, University of Colorado, 13123 E. 16th Ave, Box 090, Aurora, CO, USA. patrick.fernandez@childrenscolorado.org. 2. Department of Anesthesiology, Division of Pediatric Anesthesiology, Duke University Medical Center, Durham, NC, USA. 3. Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA. 4. Department of Anesthesiology and Critical Care, University of Texas Medical Branch, Galveston, TX, USA. 5. Department of Anesthesiology, University of Nebraska Children's Hospital and Medical Center, Omaha, NE, USA. 6. Section of Pediatric Anesthesiology, Department of Anesthesiology, Children's Hospital Colorado, University of Colorado, 13123 E. 16th Ave, Box 090, Aurora, CO, USA. 7. Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA. 8. The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Abstract
PURPOSE: Pediatric patients undergoing complex cranial vault reconstruction (CCVR) are at risk of significant perioperative blood loss requiring blood product transfusion. Minimizing allogeneic blood product transfusion is an important goal because of the associated risks and cost. The impact of patient and surgical variables on transfusion is unknown in this population. Our primary aim was to examine relationships between demographic and perioperative variables and blood product transfusion outcomes in CCVR. METHODS: The multicentre Pediatric Surgery Perioperative Registry was checked for children undergoing CCVR between June 2012 and September 2016. Univariable and multivariable analyses were performed examining patient, procedure, and blood conservation variables and their relationship to three outcomes: intraoperative red blood cell-containing product (RBC-CP) transfusion, total perioperative blood donor exposures, and transfusion-free hospitalization. RESULTS: The registry search returned data from 1,814 cases. Age and surgical duration were the only variables significantly associated with all three outcomes studied. Predictors of reduced RBC-CP transfusion included lower American Society of Anesthesiologists (ASA) physical status and antifibrinolytic administration. Total cranial vault reconstruction, intraoperative vasoactive infusion, and presence of a tracheostomy predicted increased donor exposures. Increased body weight, higher preoperative hematocrit, and utilization of intraoperative cell saver and transfusion protocols were associated with transfusion-free hospitalization. CONCLUSION: Clinical factors associated with increased allogeneic blood product transfusion in pediatric CCVR include: age ≤ 24 months, ASA status ≥ III, preoperative anemia, prolonged surgical duration, lack of intraoperative antifibrinolytic use, lack of intraoperative cell saver use, and the lack of transfusion protocols.
PURPOSE: Pediatric patients undergoing complex cranial vault reconstruction (CCVR) are at risk of significant perioperative blood loss requiring blood product transfusion. Minimizing allogeneic blood product transfusion is an important goal because of the associated risks and cost. The impact of patient and surgical variables on transfusion is unknown in this population. Our primary aim was to examine relationships between demographic and perioperative variables and blood product transfusion outcomes in CCVR. METHODS: The multicentre Pediatric Surgery Perioperative Registry was checked for children undergoing CCVR between June 2012 and September 2016. Univariable and multivariable analyses were performed examining patient, procedure, and blood conservation variables and their relationship to three outcomes: intraoperative red blood cell-containing product (RBC-CP) transfusion, total perioperative blood donor exposures, and transfusion-free hospitalization. RESULTS: The registry search returned data from 1,814 cases. Age and surgical duration were the only variables significantly associated with all three outcomes studied. Predictors of reduced RBC-CP transfusion included lower American Society of Anesthesiologists (ASA) physical status and antifibrinolytic administration. Total cranial vault reconstruction, intraoperative vasoactive infusion, and presence of a tracheostomy predicted increased donor exposures. Increased body weight, higher preoperative hematocrit, and utilization of intraoperative cell saver and transfusion protocols were associated with transfusion-free hospitalization. CONCLUSION: Clinical factors associated with increased allogeneic blood product transfusion in pediatric CCVR include: age ≤ 24 months, ASA status ≥ III, preoperative anemia, prolonged surgical duration, lack of intraoperative antifibrinolytic use, lack of intraoperative cell saver use, and the lack of transfusion protocols.
Authors: Y M Bilgin; L M G van de Watering; L Eijsman; M I M Versteegh; M H J van Oers; A Brand Journal: Transfus Med Date: 2007-08 Impact factor: 2.019
Authors: Shimian Zou; Kerri A Dorsey; Edward P Notari; Gregory A Foster; David E Krysztof; Fatemeh Musavi; Roger Y Dodd; Susan L Stramer Journal: Transfusion Date: 2010-03-12 Impact factor: 3.157
Authors: Paul A Stricker; Susan M Goobie; Franklyn P Cladis; Charles M Haberkern; Petra M Meier; Srijaya K Reddy; Thanh T Nguyen; Lingyu Cai; Marcia Polansky; Peter Szmuk; John Fiadjoe; Codruta Soneru; Ricardo Falcon; Timothy Petersen; Courtney Kowalczyk-Derderian; Nicholas Dalesio; Stefan Budac; Neels Groenewald; Daniel Rubens; Douglas Thompson; Rheana Watts; Katherine Gentry; Iskra Ivanova; Mali Hetmaniuk; Vincent Hsieh; Michael Collins; Karen Wong; Wendy Binstock; Russell Reid; Kim Poteet-Schwartz; Heike Gries; Rebecca Hall; Jeffrey Koh; Carolyn Bannister; Wai Sung; Ranu Jain; Allison Fernandez; Gerald F Tuite; Ernesto Ruas; Oleg Drozhinin; Lisa Tetreault; Bridget Muldowney; Karene Ricketts; Patrick Fernandez; Lisa Sohn; John Hajduk; Brad Taicher; Jessica Burkhart; Allison Wright; Jane Kugler; Lea Barajas-DeLoa; Meera Gangadharan; Veronica Busso; Kayla Stallworth; Susan Staudt; Kristen L Labovsky; Chris D Glover; Henry Huang; Helena Karlberg-Hippard; Samantha Capehart; Cynthia Streckfus; Kim-Phuong T Nguyen; Peter Manyang; Jose Luis Martinez; Jennifer K Hansen; Heather Mitzel Levy; Alyssa Brzenski; Franklin Chiao; Pablo Ingelmo; Razaz Mujallid; Olutoyin A Olutoye; Tariq Syed; Hubert Benzon; Adrian Bosenberg Journal: Anesthesiology Date: 2017-02 Impact factor: 7.892
Authors: Paul A Stricker; John E Fiadjoe; Amanda R Davis; Emily Sussman; Beverly J Burgess; Brian Ciampa; Jared Mendelsohn; Scott P Bartlett; Deborah A Sesok-Pizzini; David R Jobes Journal: Paediatr Anaesth Date: 2011-01 Impact factor: 2.556
Authors: Shimian Zou; Susan L Stramer; Edward P Notari; Mary C Kuhns; David Krysztof; Fatemeh Musavi; Chyang T Fang; Roger Y Dodd Journal: Transfusion Date: 2009-08 Impact factor: 3.157
Authors: Nicholas White; Ritchie Marcus; Stephen Dover; Guirish Solanki; Hiroshi Nishikawa; Carol Millar; Edmund D Carver Journal: J Craniofac Surg Date: 2009-03 Impact factor: 1.046