Research Article
Volume 4 Issue 8 - 2018
Blood Product Transfusion and Postoperative Outcome in Pediatric Neurosurgical Patients
Claudine Kumba1*, Taright H1, Terzi E1, Télion C1, Beccaria K2, Paternoster G2, Zerah M2, Bustarret O3, Jugie M3, Rubinsztajn R3 and Tréluyer JM4
11Department of Pediatric Anesthesia and Critical Care, Necker Enfants Malades University Hospital, Paris, France
22Department of Pediatric Neurosurgery, Necker Enfants Malades University Hospital, Paris Descartes University, Paris, France
3Department of Pediatric Intensive Care Unit, Necker Enfants Malades University Hospital, Paris, France
4Department of Clinical Research and Pharmacology, Necker Enfants Malades and Cochin University Hospitals, Assistance Publique Hôptaux de Paris, Paris Descartes University, Paris, France
*Corresponding Author: Claudine Kumba, Department of Pediatric Anesthesia and Critical Care, Necker Enfants Malades University Hospital, Paris, France.
Received: June 19, 2018; Published: July 12, 2018
Citation: Claudine Kumba., et al. “Blood Product Transfusion and Postoperative Outcome in Pediatric Neurosurgical Patients”. EC Anaesthesia 4.8 (2018): 288-298.
Abstract
Background: Intraoperative and postoperative morbi-mortality factors are multiple in pediatric patients. Studies in pediatric cardiac surgery and intensive care patients have identified transfusion as one factor among others. This study was undertaken to investigate whether transfusion was a risk factor of postoperative outcome in neurosurgical pediatric patients.
Objectives: To identify morbi-mortality risk factors in intraoperatively transfused and not transfused pediatric neurosurgical patients.
Design: Retrospective observational descriptive pediatric cohort study.
Patients: 206 patients with a median age of 60 months [13.25 - 135.75] were included. Inclusion criteria were the presence or the absence of transfusion in the intraoperative period in neurosurgery patients. Exclusion criterion was transfusion in the postoperative period until discharge from hospital.
Main Outcome Measures: Primary outcome was mortality and secondary outcome was morbidity in transfused and non-transfused patients. Mortality was assessed by deaths occuring intraoperatively or postoperatively during the entire hospitalisation. Morbidity was assessed by intraoperative, postoperative complications, repeat surgery, length of stay in the intensive care unit, in the hospitalisation ward, total length of stay in hospital and length of mechanical ventilation.
Results: ASA score status (odds ratio 2.49; p-value < 0.01) and transfusion (odds ratio 1.33; p-value 0.03) were predictive risk factors for complications. Emergency surgery (odds ratio 6.8; p-value 0.03) was a predictive risk factor for repeat surgery. ASA score, transfusion and emergency surgery were predictive risk factors for length of stay in the intensive care unit, total length of stay in hospital and length of mechanical ventilation (p-value < 0.0001).
Conclusion: Transfusion was identified as a morbidity risk factor among others in this pediatric cohort. Identifying these factors in order to implement improvement measures can upgrade patient postoperative outcome. One of these measures is to implement transfusion protocols in which blood product administration is guided by point of care devices such as viscoelastic methods which can contribute to reduce transfusion intraoperatively and applying blood salvage protocols such as intraoperative tranexamic acid administration and preoperative erythropoietin supplementation in potential hemorrhagic surgical interventions such as craniosynostosis.
Keywords: Blood Product Transfusion; Postoperative Outcome; Pediatric Neurosurgical Patients
Copyright: © 2018 Claudine Kumba., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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