D. O. Gonzalez1, J. N. Cooper1, E. Kelly2, P. C. Minneci1, K. J. Deans1, J. H. Aldrink1 1Nationwide Children’s Hospital,Pediatric Surgery,Columbus, OH, USA 2Ohio State University,College Of Medicine,Columbus, OH, USA
Introduction: While transfusions are thought to be associated with a higher risk of complications, there is a paucity of data on outcomes related to perioperative blood transfusion (PBT) in the pediatric population. The objective of this study was to assess whether PBT is associated with a higher risk of postoperative complications in pediatric patients undergoing resection of solid tumors.
Methods: Using the 2012-2014 NSQIP-Pediatric datasets, we identified patients aged 0 to 18 years who underwent resection of solid tumors of the liver, retroperitoneum, mediastinum, skeleton, soft tissue, ovary, kidney, or adrenal gland. We compared demographic, clinical and 30-day outcome characteristics between children who did and did not receive a PBT within 72 hours after the start of surgery using Wilcoxon rank-sum tests, Pearson chi-square tests, or Fisher exact tests. Propensity score matched analyses were used to estimate the effect of a PBT on the risk of a postoperative complication. All analyses were repeated in the subgroup of patients with liver tumors, as they were most likely to receive a PBT and develop postoperative complications.
Results: Of 961 patients who underwent resection of solid tumors, 267 (27.8%) required a PBT. Patients requiring a PBT were more likely to have preoperative risk factors, including ventilator dependence, hematologic disorders, chemotherapy, sepsis, blood transfusion within 48 hours prior to surgery, and an ASA class of 3 or greater (all p≤0.01). Postoperatively, patients requiring a PBT were more likely to have pneumonia and sepsis, and require the following: postoperative mechanical ventilation, unplanned intubation/reintubation, unplanned reoperation, and nutritional support or oxygen supplementation at discharge or at 30 days (all p<0.05). In propensity score matched analyses of 215 patient pairs, PBT was not significantly associated with overall complication risk (OR: 1.50, 95% CI: 0.97-2.32, p=0.07) but was significantly associated with an increased risk of postoperative mechanical ventilation (OR: 3.78, 95% CI: 1.81-7.88, p<0.001) and a longer length of stay (LOS) (median 7 vs. 5 days, p<0.001). Of 163 patients with liver tumors, 86 (52.8%) required a PBT, and those receiving a PBT were more likely to have any complication (51.2% vs. 32.5%, p=0.02).After propensity matching, PBT was no longer associated with a higher risk for postoperative complications (OR: 2.00, 95% CI: 0.90-4.45, p=0.09), but was still associated with a longer LOS (8 vs. 5 days, p=0.004).
Conclusion: Over 25% of children undergoing resection of solid tumors require a PBT. After accounting for demographic and clinical differences, PBT was associated with only a higher risk for postoperative mechanical ventilation and a longer LOS. Similar results were found in the subgroup of patients who underwent resection of liver tumors.