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Transfusion and Morbi-Mortality Factors: An Observational Descriptive Retrospective Pediatric Cohort Study


Journal of Anesthesia & Critical Care: Open Access
Claudine Kumba, Department of Pediatric Anesthesia and Intensive Care Necker Enfants Malades, University Hospital, France
Fabiola Cresci, Department of Pediatric Anesthesia and Intensive Care Necker Enfants Malades, University Hospital, France
Camille Picard, Department of Pediatric Anesthesia and Intensive Care Necker Enfants Malades, University Hospital, France
Cécile Thiry, Department of Pediatric Anesthesia and Intensive Care Necker Enfants Malades, University Hospital, France
Souha Albinni, Department of Transfusion (EFS, Etablissement de Sang Français), Ile de France, Necker Enfants Malades University Hospital, France
Gilles Orliaguet, Department of Anesthesia and Intensive Care Necker Enfants Malades, University Hospital, France

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 independent factor among others. There is not a lot of data concerning transfusion related morbi-mortality in other pediatric patients fields like neurosurgery, abdominal and orthopedic surgery. These were investigated.

Objectives: To identify morbi-mortality risk factors in intraoperatively transfused and not transfused pediatric patients in neurosurgery, abdominal and orthopedic surgery.

Design: Retrospective observational descriptive pediatric cohort study.

Setting: Monocentric pediatric tertiary center, Necker Enfants Malades University Hospital Paris, from 1 January 2014 to 17 Mai 2017.

Patients: 594 patients with mean age of 90.86 ± 71.80 months were included.

                        Inclusion criteria were the presence or the absence of transfusion in the intraoperative period in neurosurgery, abdominal and orthopedic surgery 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: Multivariate analysis revealed that ASA score was the independent risk factor for mortality. Transfusion, emergency surgery, type of surgery, age and prematurity were independent risk factors for morbidity.

Conclusion: Patient outcome can be improved by applying specific preventive measures on each risk factor.

Keywords

Morbi-Mortality Factors, Transfusion, Retrospective Pediatric Cohort Study, LMV, Packed red blood cells, Fresh frozen plasma, LOSICU, LOSHOSP

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