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Perioperative transfusions adversely affect post-operative outcomes in less than 18-year undergoing surgical repairs on cardiopulmonary bypass

Varuna Varma, Nirmal Gupta, Prabhaker Mishra.

Background: Cardiopulmonary bypass (CPB) induced hemodilution and coagulopathies are important causes of perioperative bleeding following heart surgeries results both in pediatric and adult patients. However, this is more pronounced in children undergoing intracardiac repair procedures due to the weight (body mass) versus blood volume mismatch in children and inherently built-in requirement of the priming volume in the bypass circuit.

Objectives: The objectives of the study were to observe and compare the impact of differing allogenic blood transfusion practices between the four groups of children under 18 years in the same institution.

Materials and Methods: A total of 791 children (excluding neonates) underwent open-heart surgery in our institute by two different surgeons (A and B) during 20062012, each following different perioperative packed red blood cell (PRBC) or blood product transfusion protocols for their patients. Children were categorized into 2 equal and matched groups in terms of their numbers (in each category of similar type of surgery). Surgeon-A, operated all children in Group A (n = 396), received with hemoglobin (Hb) ≤7 g/dl further divided into Groups 1 and 2 while Group B (n = 396) operated equal numbers in empirical transfusion protocol was followed, received with Hb ≤10 g/dl further divided into Groups 3 and 4 based on transfusion received or not received. Restricted and targeted PRBC transfusion criteria were followed in all children.

Results: Transfusion was required more often in critical and sick children and in those who have had longer CPB for complex repairs. 57.8% of children in Group B received either or both PRBC and blood product transfusion during its hospital stay. Logistic regression revealed that after adjusting the effect of their age, total chest, hospital stay, and ventilator time, had higher risk of mortality in the Group 1 (8.68, P < 0.001), Group 2 (1.38, P = 0.458), and Group 3 (5.17, P < 0.001) in contrast with Group 4 (no transfusion, Hb >10 g/dl).

Conclusion: PRBC or blood product transfusions in perioperative period adversely affect the post-operative outcomes; period of hospitalization, duration of recovery (morbidity), and survival (mortality) in children under 18 years.

Key words: Perioperative Bleeding; Hemodilution, Empirical; Restricted Blood Transfusion

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