Allogeneic Red Blood Cell Transfusion and Infectious Complications Following Pediatric Spinal Fusion

Abstract

Background: Substantial bleeding occurs during spinal fusion surgery in the pediatric population, and many patients receive allogeneic red blood cell transfusion (ARBT) for the treatment of resulting perioperative anemia. ARBT is thought to increase vulnerability to postoperative infections following major surgical procedures, but studies of this relationship in children undergoing spinal fusion have yielded conflicting results.Methods: Patients who underwent spinal fusion before the age of 18 years were identified from the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) 2016 to 2019 databases, along with patient and procedure-specific characteristics, transfusion events and volumes, and postoperative infectious complications such as wound-related infection, pneumonia, urinary tract infection (UTI), and sepsis. Multivariable logistic regression analyses provided adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for the association between ARBT and each infection outcome and the overall risk of infection.Results: Among 19,159 patients studied, 714 (3.7%) developed a total of 931 episodes of postoperative infection. In multivariable logistic regression analyses, perioperative ARBT was independently associated with postoperative pneumonia (aOR = 1.93, 95% CI = 1.40 to 2.68), UTI (aOR = 1.80, 95% CI = 1.19 to 2.73), sepsis (aOR = 1.58, 95% CI = 1.10 to 2.28), and the overall risk of infection (aOR = 1.40, 95% CI = 1.20 to 1.64). The risk of any postoperative infection increased in a dose-response fashion with transfusion volume.Conclusions: ARBT in pediatric spinal fusion is associated with significantly increased risks of postoperative pneumonia, UTI, and sepsis. The overall risk of postoperative infection increases with the volume transfused. Enhanced efforts to minimize perioperative anemia and ARBT should be considered as a means of improving patient outcomes.

Controle de sangramento em pacientes com escoliose idiopática submetidos a artrodese da coluna: Avaliação prospectiva de uma coorte de pacientes

“…Some authors suggest that blood transfusion stimulates the consumption of clotting factors and dilutes them, increasing blood loss. 1,3,4 We believe our study is clinically significant because of the role played by these variables in blood loss during idiopathic scoliosis surgeries, helping to define the patient profile with higher bleeding potential. Our findings may help other colleagues to optimize their patients' perioperative conditions, minimizing surgical morbidity.…”

“…Managing blood loss is essential for optimal surgical outcomes. [1][2][3][4][5] The use of fresh plasma, crystalloids, platelet concentrate, and/or packed red blood cells to minimize morbidity linked to excessive bleeding is not free of complications. As such, reducing perioperative blood loss may decrease the need for these measures.…”

“…However, although effective, it can result in excessive bleeding. [1][2][3] It is estimated that subjects undergoing PVA present an average loss of 21% of their estimated blood volume (EBV). In addition, 18% require a blood transfusion.…”

“…Potential complications include viral infection (hepatitis B [HBV], hepatitis C (HCV), and human immunodeficiency virus [HIV]), surgical site infection, pneumonia, urinary tract infection, alloimmunization, acute lung injury, circulatory overload, renal failure, and coagulopathy. 1,3 Knowledge about the factors predisposing to increased perioperative bleeding in patients undergoing PVA is fundamental to minimizing these unfavorable outcomes.…”

“…No entanto, apesar de eficaz, pode resultar em sangramento excessivo. 1 2 3 Estima-se que indivíduos submetidos à AVP apresentam, em média, a perda de 21% de seu volume sanguíneo estimado (VSE). Além disso, 18% necessitam de transfusão sanguínea.…”