Procedure-specific preoperative red blood cell preparation and utilization management in pediatric surgical patients.

BACKGROUND

Data-driven practices in preoperative red blood cell (RBC) preparation for pediatric surgical procedures are not well established. Adaptation of established adult preparation guidance methods to pediatric populations may improve perioperative RBC utilization.

STUDY DESIGN AND METHODS

A retrospective audit of preoperative RBC preparation volumes (Vp) and intraoperative RBC transfusion volumes (Vt) for pediatric surgical procedures was undertaken at a large children's hospital from January to June 2006. RBC preparation-to-transfusion volume (mL/kg) ratios (P:T) were calculated for all surgeries, subspecialties, and select procedures. P:T equals Vp divided by Vt. Resulting P:Ts were compared to a target P:T of 2:1. A model for maximum procedure-specific Vp (Vp-max) defined Vp-max as the RBC transfusion volume able to meet the needs of 80% of patients undergoing an individual surgical procedure. Vp-max values were applied to the study data set to predict the impact on P:Ts and Vp.

RESULTS

RBCs were prepared for 332 surgical procedures and transfused during 113 procedures. P:T was 3.5:1 for total surgical procedures (subspecialty range, 2.7:1-46:0), exceeding the 2:1 target. Vp-max modeling for spinal fusion, craniotomy for neoplasia, craniotomy for seizure, and craniosynostectomy yielded P:T ratios of 1.5:1, 1.5:1, 1.7:1, and 1.0:1, respectively, predicting a 30% decrease in Vp for these four surgical procedures.

CONCLUSIONS

P:Ts for pediatric surgical procedures at this institution indicate potentially excessive preoperative RBC preparations. Determination of data-driven procedure-specific Vp may increase the efficiency of preoperative RBC preparation practices.