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

Abstract

The hip is the second most common joint involved in pediatric patients with cerebral palsy (CP). Hip reconstructive procedures are performed to improve function and comfort level. Blood loss can occur leading to blood transfusion in close to 1/3 of children with CP undergoing hip reconstruction. The purpose of this study was to report the rate and risk factors for blood transfusion after hip reconstruction in a large cohort of children with CP. We conducted a retrospective chart review of pediatric patients at our tertiary referral children’s hospital who underwent reconstructive hip osteotomy over an 8-year period. Binary logistic regression was employed to compare and model differences in transfusion between age greater than 4 or 6 years and the number of osteotomies. A total of 180 patients met our inclusion criteria. Thirty-seven patients (20.6%) received blood transfusion. Incidence of transfusion increased as number of osteotomies increased from 1 to 4 (3.7%, 7.3%, 34.0%, 58.3%, respectively). We did not find a significant effect of age greater than 4 or 6 years on the rate of blood transfusion (P = 0.676 and P = 0.323, respectively). The number of osteotomies was a significant factor in the rate of blood transfusion in both models (P < 0.001). Number of osteotomies and not age was a significant risk factor in the rate of blood transfusion. This data can help the orthopedic surgeons in preoperative planning for the possibility of blood transfusion in these patients.

Hip reconstruction in children with cerebral palsy: does magnitude of surgery influence complications and outcomes?

“…Oladeji et al . found an increasing incidence of transfusion with increasing number of femoral or pelvic osteotomies during a single stage reconstruction [19]. The authors reported similar rates of transfusion for patients undergoing three or four osteotomies (34% and 58.3%, respectively).…”

Does epinephrine use reduce perioperative blood loss during pelvic and femoral osteotomy with open reduction of the patients with developmental dysplasia of the hip?

“…58.4%). [ 7 ] In pediatric patients, significant amounts of blood loss and blood transfusions are associated with prolonged length of hospital stay (LOS), increased transfusion reactions, and high infection risk. [ 8 , 9 ] The protective precautions required to minimize intra- and postoperative blood loss and to prevent transfusion and complications have been discussed in the literature.…”