Hemoglobin Levels and Postoperative Outcome in Pediatric Surgical Patients| Stephy Publishers

 


SOJ Pediatrics and Clinical Neonatology - (SOJPCN)| Stephy Publishers


Abstract

Background: Postoperative outcome in children is multifactorial. Among the reported predictors of postoperative outcome, preoperative anemia has been related to adverse outcome in children. A secondary analysis was undertaken to determine the correlation between hemoglobin levels and postoperative outcome in children included in a cohort of an observational pediatric study published previously since this analysis has not been done.

Objective: To determine the correlation between preoperative, intra-operative, postoperative hemoglobin levels and postoperative outcome in children in neurosurgery, abdominal and orthopedic surgery.

Methods: Secondary analysis of a sub-cohort of 252 pediatric surgical patients with a median age of 62 months [12.50-144.00].

Results: Preoperative hemoglobin levels were negatively correlated to length of stay in the intensive care unit (LOSICU) (p=0.002), to length of hospital stay (LOS) (p<0.0001), to the number of patients with intra-operative and/or postoperative complications (p<0.0001) and to re-surgery (p<0001). Low preoperative hemoglobin levels below 6g/dL were correlated to higher postoperative LOSICU and LOS. Intra-operative hemoglobin levels were negatively correlated to LOS (p<0.0001) and to the number of patients with intra-operative and/or postoperative complications (p=0.004). Low intra-operative hemoglobin levels below 5g/dL were correlated to higher LOS. Postoperative hemoglobin levels were positively correlated to LMV (p=0.002).

Conclusion: Hemoglobin levels are among other multifactorial predictors of postoperative outcome in pediatric surgical patients emphasizing the importance of a global patient blood management implementation program to improve outcome in surgical children.

Keywords: Anemia, Hemoglobin levels, Pediatric surgery, Postoperative outcome, Patient blood management, Transfusion

Introduction
It has been evidenced that in pediatric neurosurgery, abdominal and orthopedic surgery, ASA score (American Society of Anesthesiologists score), transfusion, emergency surgery, age, type of surgery were independent predictive factors of postoperative outcomes in terms of organ dysfunction, length of intensive care unit stay (LOSICU), length of mechanical ventilation (LMV), length of hospital stay (LOS) and total length of hospital stay, (TLOS) (LOSICU+LOS).1-4 In a study where 594 surgical patients with a mean age of90.86±71.80 months were retrospectively included, transfusion concerned all type of blood products precisely packed red blood cells (PRBC), fresh frozen plasma (FFP) and concentrated platelets units (CPU).1 Immunomodulation and immune reactions have been evoked as explanations of transfusion related adverse outcome such as transfusion related lung injury (TRALI), transfusion associated cardio-circulatory overload (TACO).5 Goal directed transfusion protocols with point-of-care tests have demonstrated reduction of blood products administration such as fresh frozen plasma and reduction of LOS in pediatric hemorrhagic surgery. 6 Anemia has been reported as a predictive factor of morbi-mortality in children.7,8 Weighing the benefits and risks of transfusion and anemia is mandatory to improve outcome in patients. A multicentre prospective study in pediatric intensive care patients demonstrated that a restrictive transfusion management in critically ill children did not increase adverse outcome compared to a liberal transfusion strategy.9 Transfusion triggers are not absolute and depend on patient status and clinical context. The aim of this article was to determine whether there was a correlation between preoperative, intra-operative and postoperative hemoglobin levels and postoperative outcome in terms of postoperative complications, re-surgery, mortality, LOSICU, LOS, TLOS and LMV in children included in the observational retrospective study since this data was not analyzed then.


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