Blood transfusion following major orthopaedic surgery in cerebral palsy: a retrospective analysis

Abstract

Background Progressive musculoskeletal pathology is ubiquitous among children with cerebral palsy (CP). Corrective surgery places them at risk of major blood loss and red blood cell (RBC) transfusion. Significant variability exists in uptake of perioperative patient blood management (PBM) strategies. This study aimed to examine factors contributing to RBC transfusion and assist in future development of care pathways. Methods A retrospective review at a tertiary paediatric hospital was undertaken to identify patients with CP undergoing either primary spinal fusion or single event, multilevel surgery (SEMLS) between 2010 and 2015. Solely soft tissue procedures were excluded. Data collected included demographics, Gross Motor Function Classification System level, surgical details, perioperative PBM and transfusion rates. Univariable analysis was performed to assess contributing factors to RBC transfusion. Results A total of 36 spinal fusion and 98 SEMLS patients were included. Preoperatively, 12% were anaemic, but only 19% had a ferritin checked. Overall, 49 patients (37%) received RBC transfusions. Intraoperative usage of tranexamic acid and cell salvage was 89% and 81%, respectively, for the spine cohort, and 22% and 3% for the SEMLS cohort. Successively higher Gross Motor Function Classification System levels, sodium valproate usage, longer surgical times, spinal fusion, pelvis instrumentation and more osteotomies were associated with RBC transfusion. Conclusion More than one‐third of CP patients who underwent major orthopaedic surgery received RBC transfusion. As expected, the more severely affected patients undergoing longer procedures were at highest risk. Significant improvements can be made in PBM to help optimize patients for surgery and minimize the need for transfusion.

Can We Extend the Indications for Multilevel Surgery to Non-Ambulatory Children with Neuromuscular Diseases? A Safety and Efficacy Study

“…Both the benefit of the relative lengthening of the muscles in relation to the bone produced by shortening and the need to avoid substantial length discrepancies between the lower extremities justify the need to act on the contralateral limb. The only other complication recorded in our study was blood loss requiring transfusion, which is consistent with other studies on major orthopedic surgery in patients with CP [16,21]. In this context, in which all our surgeries had a high surgical burden, including technically demanding procedures such as a BFO, and with complications being reasonable and manageable, we consider it rational to contemplate SEMLS in non-ambulatory children, provided the team of surgeons is sufficiently experienced and coordinated.…”

Blood loss in hip reconstructive surgery in children with cerebral palsy: when do I need to be prepared for blood transfusion?

“…Similarly, in a 2020 retrospective review of a tertiary pediatric hospital, Lu et al . reported a blood transfusion rate of 37.0% among CP patients who underwent major orthopedic surgeries [17]. Our findings may differ from these prior studies due to the transfusion practices between different institutions and operative time and technique among different surgeons.…”