Independent Risk Factors for RBC Transfusion in Children Undergoing Surgery. Analysis of 14,248 Cases at a German University Hospital

Piekarski, Florian; Neef, Vanessa; Meybohm, Patrick; Rolle, Udo; Schneider, W.; Zacharowski, Kai; Schmitt, Elke

doi:10.3390/children8080634

Cited by 5 publications

(3 citation statements)

References 21 publications

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“…The number of investigated paediatric patients in our study is low; however, similar to adult patients, pre-operative anaemia in paediatric patients is independently associated with an increased risk for postoperative complications [19] and mortality [20]. An analysis of > 14,000 surgical paediatric patients demonstrated that 10.1% receive blood transfusions and that pre-operative anaemia is an independent predictor for transfusion in these patients (p < 0.001; OR = 15.10 with pre-operative anaemia and OR = 2.40 without pre-operative anaemia) [21]. Therefore, there is also an urgent need to provide pre-operative anaemia management for the paediatric patient population [22][23][24].…”

Section: Resultsmentioning

confidence: 99%

Prevalence of pre‐operative anaemia in surgical patients: a retrospective, observational, multicentre study in Germany

et al. 2022

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Anaemia is a risk factor for several adverse postoperative outcomes. Detailed data about the prevalence of anaemia are not available over a long time-period in Germany. In this retrospective, observational, multicentre study, patients undergoing surgery in March in 2007March in , 2012March in , 2015March in , 2017March in and 2019 were studied. The primary objective was the prevalence of anaemia at hospital admission. The secondary objectives were the association between anaemia and the number of units of red blood cells transfused, length of hospital stay and in-hospital mortality. A total of 23,836 patients were included from eight centres. The prevalence of pre-operative anaemia in patients aged ≥ 18 years decreased slightly from 37% in 2007 to 32.5% in 2019 (p = 0.01) and increased in patients aged ≤ 18 years from 18.8% in 2007 to 26.4% in 2019 (p > 0.001). The total amount of blood administered per 1000 patients decreased from 671.2 units in 2007 to 289.0 units in 2019. Transfusion rates in anaemic patients declined from 33.8% in 2007 to 19.1% in 2019 (p < 0.001) and in non-anaemic patients from 8.4% in 2007 to 3.4% in 2019 (p < 0.001). Overall, the mortality rate remained constant over the years: 2.9% in 2007, 2.1% in 2012, 2.5% in 2015, 1.9% in 2017 and 2.5% in 2019. In the presence of anaemia, mortality was significantly increased compared with patients without anaemia ; p < 0.001). Red blood cell transfusion was associated with an increased risk of mortality ; p < 0.001). Using multivariable linear regression analysis with fixed effects, we found that pre-operative anaemia (OR 2.08 (95%CI 1.42-3.05); p < 0.001) and red blood cell transfusion (OR 4.29 (95%CI 3.09-5.94); p < 0.001) were predictors of mortality but not length of stay (0.99 (95%CI 0.98-1.00) days; p = 0.12) and analysed years (2007 vs. 2019: OR 1.49 (95%CI 0.86-2.69); p = 0.07). Pre-operative anaemia affects more than 30% of surgical patients in Germany and multidisciplinary action is urgently required to reduce adverse outcomes.

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Section: Resultsmentioning

confidence: 99%

Prevalence of pre‐operative anaemia in surgical patients: a retrospective, observational, multicentre study in Germany

et al. 2022

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“…Prompt and sufficient allogeneic blood product transfusion is often necessary to restore the oxygen transport capacity, maintain tissue oxygenation, maintain hemodynamics, and avoid cardiovascular failure. However, the efficacy and safety of blood transfusion remain concerns [2,3].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a Pre-Filled Table and a Flowchart-Based Algorithm as Cognitive Aids to Reduce Deviations in Dose Calculation for Intraoperative Red Blood Cell Transfusions in Children—An International Web-Based Simulation

et al. 2023

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Background: Transfusion of red blood cell concentrate can be life-saving, but requires accurate dose calculations in children. Aims: We tested the hypothesis that cognitive aids would improve identification of the correct recommended volumes and products, according to the German National Transfusion guidelines, in pediatric transfusion scenarios. Methods: Four online questionnaire-based scenarios, two with hemodynamically stable and two with hemodynamically unstable children, were sent to German and international pediatric anesthetists for completion. In the two stable scenarios, participants were given pre-filled tables that contained all required information. For the two emergency scenarios, existing algorithms were used and required calculation by the user. The results were classified into three categories of deviations from the recommended values (DRV): DRV120 (<80% or >120%), as the acceptable variation; DRV 300 (<33% or >300%), the deviation of concern for potential harm; and DRV 1000 (<10% or >1000%), the excessive deviation with a high probability of harm. Results: A total of 1.458 pediatric anesthetists accessed this simulation questionnaire, and 402 completed questionnaires were available for analysis. A pre-filled tabular aid, avoiding calculations, led to a reduction in deviation rates in the category of DRV120 by 60% for each and of DRV300 by 17% and 20%, respectively. The use of algorithms as aids for unstable emergencies led to a reduction in the deviation rate only for DRV120 (20% and 15% respectively). In contrast, the deviation rates for DRV300 and DRV1000 rose by 37% and 16%, respectively. Participants used higher transfusion thresholds for the emergency case of a 2-year-old compromised child than for the stable case with a patient of the same age (on average, 8.6 g/dL, 95% CI 8.5–8.8 versus 7.1 g/dL, 95% CI 7.0–7.2, p < 0.001) if not supported by our aids. Participants also used a higher transfusion threshold for unstable children aged 3 months than for stable children of the same age (on average, 8.9 g/dL, 95% CI 8.7–9.0 versus 7.9 g/dL, 95% CI 7.7–8.0, p < 0.001). Conclusions: The use of cognitive aids with precalculated transfusion volumes for determining transfusion doses in children may lead to improved adherence to published recommendations, and could potentially reduce dosing deviations outside those recommended by the German national transfusion guidelines.

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“…The benefits of minimally invasive surgery are well-known and have been reported multiple times in medical literature. The most important benefits include: faster recovery and return to everyday activities, less pain, a shorter hospital stay, fewer complications and better cosmetic effects [ 1 , 2 , 3 , 4 , 5 , 6 , 7 ].…”

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confidence: 99%

Advances and Future Challenges of Minimally Invasive Surgery in Children

Pogorelić

2022

Children

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Independent Risk Factors for RBC Transfusion in Children Undergoing Surgery. Analysis of 14,248 Cases at a German University Hospital

Cited by 5 publications

References 21 publications

Prevalence of pre‐operative anaemia in surgical patients: a retrospective, observational, multicentre study in Germany

Prevalence of pre‐operative anaemia in surgical patients: a retrospective, observational, multicentre study in Germany

Evaluation of a Pre-Filled Table and a Flowchart-Based Algorithm as Cognitive Aids to Reduce Deviations in Dose Calculation for Intraoperative Red Blood Cell Transfusions in Children—An International Web-Based Simulation

Advances and Future Challenges of Minimally Invasive Surgery in Children

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