Changes in red blood cell transfusion practice during the past quarter century: a retrospective analysis of pediatric patients undergoing elective scoliosis surgery using the Mayo database.

BACKGROUND CONTEXT

Previous studies have demonstrated significant changes in red blood cell (RBC) transfusion practice over several decades.

PURPOSE

The purpose of the present study was to ascertain changes in transfusion practice during a 25-year study epoch and determine whether these changes had any impact on the frequency of perioperative morbidity and mortality in pediatric patients undergoing major spine surgery.

STUDY DESIGN

Retrospective chart review.

PATIENT SAMPLE

Pediatric patients undergoing elective scoliosis surgery.

OUTCOME MEASURES

Impact of RBC transfusion on perioperative morbidity and mortality.

METHODS

Pediatric patients undergoing elective scoliosis surgery were stratified into one of two transfusion-related groups: 1975 to 1985 (ie, pre-human immunodeficiency virus screening, early practice group, n=177) or 1990 to 2000 (ie, recent practice group, n=192). Transfusion and perioperative outcome data were obtained from medical records. Red blood cell use was analyzed as a continuous variable and compared between groups using the Wilcoxon rank sum test, as were preoperative, postoperative, and discharge hemoglobin concentration. Age-adjusted data were compared between groups using chi-square or Fisher exact tests.

RESULTS

Patients in the recent practice group had significantly worse comorbid disease and more complex procedures compared with those in the early practice group. The percentage of patients in the recent practice group receiving allogeneic RBC transfusions was significantly less than the early group (37.5% vs. 89.8%, p<.001). Utilization of autologous RBC and intraoperative autotransfusion was significantly greater in the recent practice group (5.1% vs. 47.4% and 20.9% vs. 95.8%, respectively). Hemoglobin concentrations were significantly lower for all time periods in the recent practice group. There were no differences in major morbidity or mortality between groups.

CONCLUSIONS

In this retrospective review, we report a significant change in blood management strategies in pediatric patients undergoing elective scoliosis surgery. We demonstrated a shift from utilization of allogeneic RBC transfusion toward preoperative donation and intraoperative autotransfusion. Although transfusion triggers were significantly lower in the recent practice group, we were unable to demonstrate a difference in major morbidity or mortality. Utilization of autologous RBC transfusion was safe and effective in reducing allogeneic RBC transfusions in this study. The advantages of autologous blood transfusion may be in preserving a relatively scarce resource (ie, allogeneic blood), rather than mitigating transfusion-related complications.