Faculty Collaboration Database

Transfusions in Children's Surgery: Characterization and Development of a Model for Benchmarking. J Surg Res 2020 Aug;252:47-56

Date

03/31/2020

Pubmed ID

32222593

DOI

10.1016/j.jss.2019.11.024

Scopus ID

2-s2.0-85082188616 (requires institutional sign-in at Scopus site)   2 Citations

Abstract

BACKGROUND: Perioperative blood transfusions in children are associated with patient morbidity and are often overutilized. In this study, we identify procedures most commonly associated with the use of red blood cells (RBC) in childrens surgery and develop risk-adjusted models for benchmarking.

METHODS: Data from the 2012-2015 National Surgical Quality Improvement Program-Pediatric participant use data files were used. CPT (Current Procedural Terminology) codes were grouped to identify the procedures where transfusions were allocated and associated patient demographics and comorbidities. Patients were stratified in two age groups (0-3 mo and 3 mo to 18 y), and a logistic regression model was developed for each age group.

RESULTS: Of 369,176 total cases, 21,410 (5.8%) were associated with a perioperative transfusion. 659 CPT codes were grouped in 207 clusters according to their similarities. The most common procedures associated with transfusion were arthrodesis for spinal deformity (n = 9533, 44.5%), followed by craniectomy for craniosynostosis (n = 1853, 8.7%). The logistic regression model for patients <3 mo included 18 variables and had excellent discriminatory performance (area under the curve 0.866). The model for patients ≥3 mo to 18 y had 21 variables and an area under the curve of 0.911.

CONCLUSIONS: The majority of transfusions used in children's surgery are concentrated within a relatively few procedural groups. These findings can help centers in focusing blood optimization efforts on common surgeries with high transfusion rates. In addition, multiple preoperative factors have been built into a risk-adjusted model that can be used for benchmarking blood transfusions among hospitals.

Author List

Salazar JH, Goldstein SD, Swarup A, Boss EF, Van Arendonk KJ, Abdullah F

MESH terms used to index this publication - Major topics in bold

Adolescent
Australia
Benchmarking
Child
Child, Preschool
Erythrocyte Transfusion
Female
Hospitals, Pediatric
Humans
Infant
Infant, Newborn
Intraoperative Complications
Logistic Models
Male
Models, Organizational
Perioperative Care
Postoperative Complications
Risk Factors
Surgical Procedures, Operative
United Arab Emirates
United States