Cargando…
Allogeneic Red Blood Cell Transfusion and Infectious Complications Following Pediatric Spinal Fusion: NSQIP-P Analysis
Substantial bleeding occurs during spinal fusion surgery in the pediatric population, and many patients receive allogeneic red blood cell transfusion (ARBT) for the treatment of resulting perioperative anemia. ARBT is thought to increase vulnerability to postoperative infections following major surg...
Autores principales: | , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Journal of Bone and Joint Surgery, Inc.
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9586922/ https://www.ncbi.nlm.nih.gov/pubmed/36285249 http://dx.doi.org/10.2106/JBJS.OA.22.00038 |
_version_ | 1784813791996805120 |
---|---|
author | Eisler, Lisa Hassan, Fthimnir Lenke, Lawrence G. Chihuri, Stanford Hod, Eldad A. Li, Guohua |
author_facet | Eisler, Lisa Hassan, Fthimnir Lenke, Lawrence G. Chihuri, Stanford Hod, Eldad A. Li, Guohua |
author_sort | Eisler, Lisa |
collection | PubMed |
description | Substantial bleeding occurs during spinal fusion surgery in the pediatric population, and many patients receive allogeneic red blood cell transfusion (ARBT) for the treatment of resulting perioperative anemia. ARBT is thought to increase vulnerability to postoperative infections following major surgical procedures, but studies of this relationship in children undergoing spinal fusion have yielded conflicting results. METHODS: Patients who underwent spinal fusion before the age of 18 years were identified from the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) 2016 to 2019 databases, along with patient and procedure-specific characteristics, transfusion events and volumes, and postoperative infectious complications such as wound-related infection, pneumonia, urinary tract infection (UTI), and sepsis. Multivariable logistic regression analyses provided adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for the association between ARBT and each infection outcome and the overall risk of infection. RESULTS: Among 19,159 patients studied, 714 (3.7%) developed a total of 931 episodes of postoperative infection. In multivariable logistic regression analyses, perioperative ARBT was independently associated with postoperative pneumonia (aOR = 1.93, 95% CI = 1.40 to 2.68), UTI (aOR = 1.80, 95% CI = 1.19 to 2.73), sepsis (aOR = 1.58, 95% CI = 1.10 to 2.28), and the overall risk of infection (aOR = 1.40, 95% CI = 1.20 to 1.64). The risk of any postoperative infection increased in a dose-response fashion with transfusion volume. CONCLUSIONS: ARBT in pediatric spinal fusion is associated with significantly increased risks of postoperative pneumonia, UTI, and sepsis. The overall risk of postoperative infection increases with the volume transfused. Enhanced efforts to minimize perioperative anemia and ARBT should be considered as a means of improving patient outcomes. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. |
format | Online Article Text |
id | pubmed-9586922 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Journal of Bone and Joint Surgery, Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-95869222022-10-24 Allogeneic Red Blood Cell Transfusion and Infectious Complications Following Pediatric Spinal Fusion: NSQIP-P Analysis Eisler, Lisa Hassan, Fthimnir Lenke, Lawrence G. Chihuri, Stanford Hod, Eldad A. Li, Guohua JB JS Open Access Scientific Articles Substantial bleeding occurs during spinal fusion surgery in the pediatric population, and many patients receive allogeneic red blood cell transfusion (ARBT) for the treatment of resulting perioperative anemia. ARBT is thought to increase vulnerability to postoperative infections following major surgical procedures, but studies of this relationship in children undergoing spinal fusion have yielded conflicting results. METHODS: Patients who underwent spinal fusion before the age of 18 years were identified from the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) 2016 to 2019 databases, along with patient and procedure-specific characteristics, transfusion events and volumes, and postoperative infectious complications such as wound-related infection, pneumonia, urinary tract infection (UTI), and sepsis. Multivariable logistic regression analyses provided adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for the association between ARBT and each infection outcome and the overall risk of infection. RESULTS: Among 19,159 patients studied, 714 (3.7%) developed a total of 931 episodes of postoperative infection. In multivariable logistic regression analyses, perioperative ARBT was independently associated with postoperative pneumonia (aOR = 1.93, 95% CI = 1.40 to 2.68), UTI (aOR = 1.80, 95% CI = 1.19 to 2.73), sepsis (aOR = 1.58, 95% CI = 1.10 to 2.28), and the overall risk of infection (aOR = 1.40, 95% CI = 1.20 to 1.64). The risk of any postoperative infection increased in a dose-response fashion with transfusion volume. CONCLUSIONS: ARBT in pediatric spinal fusion is associated with significantly increased risks of postoperative pneumonia, UTI, and sepsis. The overall risk of postoperative infection increases with the volume transfused. Enhanced efforts to minimize perioperative anemia and ARBT should be considered as a means of improving patient outcomes. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. Journal of Bone and Joint Surgery, Inc. 2022-10-24 /pmc/articles/PMC9586922/ /pubmed/36285249 http://dx.doi.org/10.2106/JBJS.OA.22.00038 Text en Copyright © 2022 The Authors. Published by The Journal of Bone and Joint Surgery, Incorporated. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. |
spellingShingle | Scientific Articles Eisler, Lisa Hassan, Fthimnir Lenke, Lawrence G. Chihuri, Stanford Hod, Eldad A. Li, Guohua Allogeneic Red Blood Cell Transfusion and Infectious Complications Following Pediatric Spinal Fusion: NSQIP-P Analysis |
title | Allogeneic Red Blood Cell Transfusion and Infectious Complications Following Pediatric Spinal Fusion: NSQIP-P Analysis |
title_full | Allogeneic Red Blood Cell Transfusion and Infectious Complications Following Pediatric Spinal Fusion: NSQIP-P Analysis |
title_fullStr | Allogeneic Red Blood Cell Transfusion and Infectious Complications Following Pediatric Spinal Fusion: NSQIP-P Analysis |
title_full_unstemmed | Allogeneic Red Blood Cell Transfusion and Infectious Complications Following Pediatric Spinal Fusion: NSQIP-P Analysis |
title_short | Allogeneic Red Blood Cell Transfusion and Infectious Complications Following Pediatric Spinal Fusion: NSQIP-P Analysis |
title_sort | allogeneic red blood cell transfusion and infectious complications following pediatric spinal fusion: nsqip-p analysis |
topic | Scientific Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9586922/ https://www.ncbi.nlm.nih.gov/pubmed/36285249 http://dx.doi.org/10.2106/JBJS.OA.22.00038 |
work_keys_str_mv | AT eislerlisa allogeneicredbloodcelltransfusionandinfectiouscomplicationsfollowingpediatricspinalfusionnsqippanalysis AT hassanfthimnir allogeneicredbloodcelltransfusionandinfectiouscomplicationsfollowingpediatricspinalfusionnsqippanalysis AT lenkelawrenceg allogeneicredbloodcelltransfusionandinfectiouscomplicationsfollowingpediatricspinalfusionnsqippanalysis AT chihuristanford allogeneicredbloodcelltransfusionandinfectiouscomplicationsfollowingpediatricspinalfusionnsqippanalysis AT hodeldada allogeneicredbloodcelltransfusionandinfectiouscomplicationsfollowingpediatricspinalfusionnsqippanalysis AT liguohua allogeneicredbloodcelltransfusionandinfectiouscomplicationsfollowingpediatricspinalfusionnsqippanalysis |