Location

LSU Health Sciences Center - New Orleans

Event Website

https://digitalscholar.lsuhsc.edu/surgery_s/

Document Type

Event

Start Date

4-5-2023 8:00 AM

End Date

4-5-2023 8:10 AM

Description

Purpose:

Perioperative transfusion guidelines for pediatric sickle cell disease (SCD) patients are underdeveloped. The American Society of Hematology currently provides transfusion recommendations for procedures requiring general anesthesia and lasting more than 1 hour. These guidelines, while considered ‘low certainty evidence,’ aim to reduce vaso-occlusive crises and other perioperative complications. Many pediatric SCD patients require long term central venous access, however these short procedures do not fall within the aforementioned guidelines. Therefore, transfusion recommendations for these specific procedures are unknown. The objective of this study is to investigate our institutional practice and evaluate postoperative outcomes of SCD patients undergoing central venous access procedures.

Methods:

A retrospective chart review was performed from 2018-2022 of SCD patients who underwent a line placement or removal at a stand-alone quaternary care children’s hospital. Patients were grouped as initial hemoglobin (Hgb) <9g/dL or Hgb ≥9g/dL and those who underwent preoperative transfusions or not. Clinical information including demographics, Hgb levels, number of transfusions, operative and anesthesia times, and postoperative complications were collected. Statistical analysis was performed using Fisher exact and Wilcoxon rank sum tests.

Results:

30 patients underwent 34 venous access procedures (76% line placement, 36% line removal) with a median age of 16 years. 23 patients (76%) experienced at least one previous sickle cell crisis. Half of the patients (15) had an initial Hgb <9g/dL and there were no significant differences in the demographics between the groups. 2 patients with a Hgb <9g/dL had a postoperative complication (venous thromboembolism and stroke) while 1 patient with a Hgb >9g/dL had a complication (stroke). The incidence of complications and readmission rates were not significantly different. 14 of patients (47%) received a preoperative blood transfusion, with an average pretransfusion Hgb of 8.5 (7.5-11.2). 25% of patients who did not receive a transfusion had a preoperative Hgb <9g/dL. Length of stay, postoperative complications, intraoperative transfusion, and readmission rates were not significantly different in patients who received a preoperative transfusion.

Conclusion:

We encountered variability in the preoperative transfusion threshold of patients undergoing venous access procedures. However, outcomes remained similar with no significant differences based on preoperative Hgb or transfusion rates. Future studies focused on quality, safety, and resource allocation are needed for development of practice recommendations. The eventual development of an evidence-based, standardized protocol is necessary to minimize complications and provide consistent, optimal care

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May 4th, 8:00 AM May 4th, 8:10 AM

To transfuse or not to transfuse? Preoperative transfusion practices for pediatric Sickle Cell Patients Undergoing Central Venous Access Procedures

LSU Health Sciences Center - New Orleans

Purpose:

Perioperative transfusion guidelines for pediatric sickle cell disease (SCD) patients are underdeveloped. The American Society of Hematology currently provides transfusion recommendations for procedures requiring general anesthesia and lasting more than 1 hour. These guidelines, while considered ‘low certainty evidence,’ aim to reduce vaso-occlusive crises and other perioperative complications. Many pediatric SCD patients require long term central venous access, however these short procedures do not fall within the aforementioned guidelines. Therefore, transfusion recommendations for these specific procedures are unknown. The objective of this study is to investigate our institutional practice and evaluate postoperative outcomes of SCD patients undergoing central venous access procedures.

Methods:

A retrospective chart review was performed from 2018-2022 of SCD patients who underwent a line placement or removal at a stand-alone quaternary care children’s hospital. Patients were grouped as initial hemoglobin (Hgb) <9g/dL or Hgb ≥9g/dL and those who underwent preoperative transfusions or not. Clinical information including demographics, Hgb levels, number of transfusions, operative and anesthesia times, and postoperative complications were collected. Statistical analysis was performed using Fisher exact and Wilcoxon rank sum tests.

Results:

30 patients underwent 34 venous access procedures (76% line placement, 36% line removal) with a median age of 16 years. 23 patients (76%) experienced at least one previous sickle cell crisis. Half of the patients (15) had an initial Hgb <9g/dL and there were no significant differences in the demographics between the groups. 2 patients with a Hgb <9g/dL had a postoperative complication (venous thromboembolism and stroke) while 1 patient with a Hgb >9g/dL had a complication (stroke). The incidence of complications and readmission rates were not significantly different. 14 of patients (47%) received a preoperative blood transfusion, with an average pretransfusion Hgb of 8.5 (7.5-11.2). 25% of patients who did not receive a transfusion had a preoperative Hgb <9g/dL. Length of stay, postoperative complications, intraoperative transfusion, and readmission rates were not significantly different in patients who received a preoperative transfusion.

Conclusion:

We encountered variability in the preoperative transfusion threshold of patients undergoing venous access procedures. However, outcomes remained similar with no significant differences based on preoperative Hgb or transfusion rates. Future studies focused on quality, safety, and resource allocation are needed for development of practice recommendations. The eventual development of an evidence-based, standardized protocol is necessary to minimize complications and provide consistent, optimal care

https://digitalscholar.lsuhsc.edu/surgery_s/2023/postera/1