Risk factors for complications after abdominal surgery in children with sickle cell disease

Snyder, Christopher W.; Bludevich, Bryce M.; González, Raquel; Danielson, Paul D.; Chandler, Nicole M.

doi:10.1016/j.jpedsurg.2020.08.034

Cited by 10 publications

(4 citation statements)

References 21 publications

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“…The occurrence of a postoperative VOE in our series was more frequent in patients operated in an urgent setting (44%). In a large American pediatric study evaluating the risk factors associated with the occurrence of postoperative vaso-occlusive complications in abdominal surgery, the urgent nature of the surgery was the only significant predictive factor of complications (OR 1.83, 95% CI 1.02–3.29, p = 0.04), whether the patients were transfused or not [ 25 ]. Likewise, in the French series conducted at Tenon Hospital by Muroni et al (103 patients), postoperative vaso-occlusive complications were less frequent in the case of a prophylactic laparoscopic cholecystectomy in asymptomatic patients (11.5%) than in patients with an acute vesicular complication (25.5%) [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Risks and Benefits of Prophylactic Transfusion before Cholecystectomy in Sickle Cell Disease

Rambaud

Ranque

Tsiakyroudi

et al. 2022

JCM

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Preoperative transfusion (PT) reduces acute postoperative vaso-occlusive events (VOE) in sickle cell disease (SCD), but exposes patients to alloimmunization, encouraging a recent trend towards transfusion sparing. The aim of this study was to investigate the benefit–risk ratio of PT before cholecystectomy on the occurrence of postoperative VOE. Adult SCD patients who underwent cholecystectomy between 2008 and 2019 in our center were included. Patients’ characteristics, collected retrospectively, were compared according to PT. A total of 79 patients were included, 66% of whom received PT. Gallbladder histopathology found chronic cholecystitis (97%) and gallstones (66%). Transfused patients underwent more urgent surgeries and had experienced more painful vaso-occlusive crises (VOC) in the month before surgery (p = 0.05). Four (8.5%) post-transfusion alloimmunizations occurred, and two of them caused a delayed hemolytic transfusion reaction (DHTR) (4.3%). The occurrence of postoperative VOE was similar between the groups (19.2% vs. 29.6%, p = 0.45). Though not statistically significant, a history of hospitalized VOC within 6 months prior to surgery seemed to be associated to postoperative VOE among non-transfused patients (75% vs. 31.6%, p = 0.10). PT before cholecystectomy exposes to risks of alloimmunization and DHTR that could be avoided in some patients. Recent VOCs appear to be associated with a higher risk of postoperative VOE and prompt the preemptive transfusion of these patients.

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Section: Discussionmentioning

confidence: 99%

Risks and Benefits of Prophylactic Transfusion before Cholecystectomy in Sickle Cell Disease

Rambaud

Ranque

Tsiakyroudi

et al. 2022

JCM

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“…A retrospective analysis was conducted using data queried from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Pediatric database. This database was chosen for its breadth on adverse events following surgical procedures, including cases from over 140 sites nationally (predominantly academic institutions), and over 400 variables covering patient demographics, comorbidities, and preoperative, intraoperative, and postoperative outcomes 14–16. This study encompasses data from 2012 to 2019, with a total of 3906 patients included in the analysis.…”

Section: Methodsmentioning

confidence: 99%

“…This database was chosen for its breadth on adverse events following surgical procedures, including cases from over 140 sites nationally (predominantly academic institutions), and over 400 variables covering patient demographics, comorbidities, and preoperative, intraoperative, and postoperative outcomes. [14][15][16] This study encompasses data from 2012 to 2019, with a total of 3906 patients included in the analysis. Of note, NSQIP data is considered de-identified at the patient, provider, and hospital levels upon publishing, therefore Institutional Review Board approval was not required for this study.…”

Section: Data Sourcementioning

confidence: 99%

Race Is Associated With Risk of Salvage Procedures and Postoperative Complications After Hip Procedures in Children With Cerebral Palsy

Brown

Cho

Tarawneh

et al. 2022

Journal of Pediatric Orthopaedics

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Background: Despite the many surgical interventions available for spastic hip dysplasia in children with cerebral palsy, a radical salvage hip procedure may still ultimately be required. The purpose of this study was to assess whether race is an independent risk factor for patients with cerebral palsy to undergo a salvage hip procedure or experience postoperative complications for hip dysplasia treatment. Methods: This is a retrospective cohort analysis utilizing the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Pediatric database from 2012 to 2019. International Classification of Diseases, 9th and 10th Revisions, Clinical Modifications (ICD-9-CM, ICD-10-CM), and current procedural terminology (CPT) codes were used to identify patients with cerebral palsy undergoing hip procedures for hip dysplasia and to stratify patients into salvage or reconstructive surgeries.Results: There was a total of 3906 patients with cerebral palsy between the ages of 2 and 18 years undergoing a procedure for hip dysplasia, including 1995 (51.1%) White patients, 768 (19.7%) Black patients, and 1143 (29.3%) patients from other races. Both Black (P = 0.044) and White (P = 0.046) races were significantly associated with undergoing a salvage versus a reconstructive hip procedure, with Black patients having an increased risk compared to White patients [adjusted odds ratio (OR) 1.77, confidence interval (CI) 1.02-3.07]. Only Black patients were found to have an increased risk of any postoperative complication compared to White patients, with an adjusted OR of 1.26 (CI 1.02-1.56; P = 0.033). Both White (P = 0.017) and black (P = 0.004) races were found to be significantly associated with medical complications, with Black patients having an increased risk (adjusted OR 1.43, CI 1.12-1.84) compared to White patients. There were no significant findings between the race and risk of surgical site complications, unplanned readmissions, or reoperations. Conclusion: This study demonstrates that patient race is an independent association for the risk of pediatric patients with cerebral palsy to both undergo a salvage hip procedure and to experience postoperative medical complications, with Black patients having an increased risk compared to White.

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“…Although there is currently no consensus on the benefit of pre-operative transfusion for patients with major sickle cell syndrome [18], their anaesthesia preparation frequently includes the transfusion of red blood cells to reduce the risk of morbidity and mortality associated with the procedure [19]. The purpose of blood transfusion in sickle cell disease is to rapidly decrease the proportion of red blood cells containing haemoglobin S, and thus to prevent harmful pathophysiological cascades.…”

Section: Elements That Did Not Have a Significant Impact On The Occurrence Of Post-operative Complicationsmentioning

confidence: 99%

Incidence of Post-Operative Complications and Factors Influencing Their Occurrence in Patients with Sickle Cell Disease in a Low-Income Country: A Case Study of Cameroon

Tamchom

Ekoube

Essola

et al. 2022

JCM

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This study aimed to analyse post-operative complications and possible factors influencing their occurrence in the management of patients with sickle cell disease in a low-income country. We prospectively collected data regarding the management of patients with sickle cell disease requiring anesthesia for surgery in 11 Cameroonian hospitals from 1 May 2019 to 30 April 2021. The data were analysed using descriptive statistics and a binary logistic regression was used to determine the dependence between the variables. A total of 124 patients with sickle cell disease were enrolled; 64 were male and 60 female, giving a sex ratio of 0.93. The rate of post-operative complications was 23.4% (29/124) and the death rate was 3.2% (4/124). The female subjects had more complications than the male subjects p < 0.05. The number of vaso-occlusive crises experienced per year showed a significant impact on the occurrence of post-operative complications p < 0.05. Laparoscopic surgery had fewer post-operative complications 5/46 (10.9%) than laparotomy 14/43 (32.5%). The surgical technique for the abdominal procedures had a significant impact on the occurrence of post-operative complications p < 0.05. The type of surgery (p = 0.198) and the anaesthesia technique (p = 0.225) did not show a significant impact on the occurrence of post-operative complications. Particular attention should be paid to female patients with sickle cell disease as they are more likely to experience post-operative complications, as well as to the frequency of vaso-occlusive crises, which are also predictive of post-operative complications. Opting for laparoscopic surgery whenever possible would help to reduce post-operative complications.

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Risk factors for complications after abdominal surgery in children with sickle cell disease

Cited by 10 publications

References 21 publications

Risks and Benefits of Prophylactic Transfusion before Cholecystectomy in Sickle Cell Disease

Risks and Benefits of Prophylactic Transfusion before Cholecystectomy in Sickle Cell Disease

Race Is Associated With Risk of Salvage Procedures and Postoperative Complications After Hip Procedures in Children With Cerebral Palsy

Incidence of Post-Operative Complications and Factors Influencing Their Occurrence in Patients with Sickle Cell Disease in a Low-Income Country: A Case Study of Cameroon

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