Blood Transfusion Incidence, Risk Factors, and Associated Complications in Surgical Treatment of Hip Dysplasia

Abstract

Background Perioperative bleeding requiring blood transfusion is a known complication of hip dysplasia (HD) surgery. Here we examine rates of, risk factors for, and postoperative complications associated with transfusion during HD surgery. Methods The National Surgical Quality Improvement Program (NSQIP) Pediatric database was queried for patients treated by an orthopedist from 2012-2013. HD cases were categorized by Current Procedural Terminology codes into femoral osteotomies, acetabular osteotomies, combined femoral/acetabular osteotomies, and open reductions. Patients were grouped by comorbidities: neuromuscular (NM) disease (e.g., Cerebral Palsy) group, non-NM with other comorbidity (Other) group, and no known comorbidity (NL) group. Patients were stratified by weight-normalized transfusion volume. Multivariate regression analysis of transfusion association with procedures, demographics, comorbidities, preoperative laboratory values, and 30-day complications was performed. Results A total of 1,184 HD cases were included. Transfusion rates for the NL, Other, and NM groups, respectively, were: 44/451 (9.8%), 61/216 (28.2%), and 161/517 (31.1%). Transfusion volumes (mean±SD) for the NL, Other, and NM groups, respectively, were: 8.4±5.4 mL/kg, 13.9±8.8 mL/kg, and 15.5±10.0 mL/kg (p<0.001).Combined osteotomies had the highest transfusion rates in the NM and Other groups (35.7% and 45.8%, respectively), whereas acetabular osteotomies had the highest rate in the NL group (15.8%). Open reductions had the lowest transfusion rate (all groups). Longer operations were independently associated with transfusion (all groups, per hour increase, OR>1.5, p<0.001). Independent patient risk factors included preoperative hematocrit <31% (NM group, OR=18.42, p=0.013), female gender (NL group, OR=3.55, p=0.008), developmental delay (NM group, OR=2.37, p=0.004), pulmonary comorbidity (NM group, OR=1.73, p=0.032), and older age (NL group, per year increase: OR=1.29, p<0.001). In all groups, transfusion was associated with longer hospitalization (p<0.001). We observed a volume-dependent increase in overall complication rate within the Other group for transfusion volumes >15 mL/kg (25.0% vs. 5.4% for <15 mL/kg, p=0.048). Conclusion We identified several risk factors for transfusion in HD surgery. The incidence of transfusion in HD surgery and its association with adverse outcomes warrants development of appropriate patient management guidelines. Level of Evidence Prognostic Level III

Thirty-Day Outcomes following Pediatric Bone and Soft Tissue Sarcoma Surgery: A NSQIP Pediatrics Analysis

“…NSQIP-P has been used to describe adverse events following common pediatric orthopedic procedures in order to identify procedures and patient characteristics associated with an increased risk of postoperative complications [26]. Other studies have considered outcomes after specific orthopedic procedures [27][28][29], most frequently involving the spine [30][31][32][33], as well as outcomes in orthopedic patients with specific risk factors such as obesity, congenital heart disease, or cerebral palsy [34][35][36]. To our knowledge, NSQIP-P has not been used to characterize outcomes after pediatric orthopedic oncology procedures.…”

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

“…Pelvic and/or femoral osteotomies for the hips and spinal fusion for scoliosis are major interventions that are associated with significant risk for large intraoperative blood loss and resultant need for allogeneic red blood cell (RBC) transfusion. 5,6 The decision to transfuse a child needs to be carefully considered as there are well-documented risks associated with RBC transfusion including allergic and haemolytic transfusion reactions, transfusiontransmitted infections, hypothermia, transfusion-associated circulatory overload and transfusion-related acute lung injury. [7][8][9] Some risks occur relatively more often in children.…”

Hospital resource use after hip reconstruction surgery in children with neurological complex chronic conditions

“…Earlier studies report that co‐occurring conditions in children are associated with higher rates of postoperative physiological decline and increased hospital resource use 10,11 . Preoperative assessment and control of co‐occurring conditions in children undergoing major operations, including hip reconstruction, is essential to minimize complications during postoperative recovery 12–14 …”

“…10,11 Preoperative assessment and control of co-occurring conditions in children undergoing major operations, including hip reconstruction, is essential to minimize complications during postoperative recovery. [12][13][14] The current study was conducted to advance knowledge on the relationship between co-occurring conditions and postoperative outcomes in children with neurological CCCs undergoing hip reconstruction surgery for hip subluxation. The objectives were to assess how multiple, co-occurring conditions influence length of postoperative in-hospital stay, cost, and 30-day hospital readmission.…”