Faculty Collaboration Database

Successful surgical outcome in children with sickle hemoglobinopathies: the Duke University experience. J Pediatr Surg 1998 Mar;33(3):428-32

Date

04/16/1998

Pubmed ID

9537552

DOI

10.1016/s0022-3468(98)90083-5

Scopus ID

2-s2.0-0031895868 (requires institutional sign-in at Scopus site)   20 Citations

Abstract

BACKGROUND/PURPOSE: Surgery in patients with sickle hemoglobinopathies can be problematic because of the potential for sickling events in the perioperative and postoperative period. The authors and others have previously reported successful surgical outcomes using an aggressive erythrocyte transfusion regimen, designed to alleviate anemia and to reduce the percentage of sickle hemoglobin to below 30%. Recently, a randomized trial compared this aggressive regimen with a more conservative transfusion regimen and found no differences in perioperative complications. The incidence of complications, however, was very high in each group (31% to 35%).

METHODS: The authors therefore analyzed retrospectively their surgical experience in children with sickle hemoglobinopathies over the past 10 years to determine the efficacy of an aggressive transfusion regimen and skilled perioperative care in their patient population.

RESULTS: A total of 130 surgical procedures were performed on 92 children including 54 cholecystectomies (42%), 23 splenectomies (18%), 12 ENT procedures (9%), 11 central line placements and removals (8%), 7 herniorrhaphies (5%), 7 appendectomies (5%), and 16 miscellaneous operations (13%). The mean age of the children was 10 years (range, 1 to 22 years), and the mean weight was 32.1 kg (range, 9.9 to 76.8 kg). The average hemoglobin (mean +/- 1 SD) at the time of surgery was 11.2+/-1.3 g/dL, and the average percent hemoglobin S was 21+/-11%.

CONCLUSIONS: Relatively few transfusions were required to achieve these endpoints, and the complications resulting from transfusions were minimal. Similarly, the number of perioperative and postoperative events was very low.

Author List

Adams DM, Ware RE, Schultz WH, Ross AK, Oldham KT, Kinney TR

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

Adolescent
Adult
Anemia, Sickle Cell
Child
Child, Preschool
Humans
Infant
Intraoperative Complications
Postoperative Complications
Preoperative Care
Retrospective Studies
Surgical Procedures, Operative
Transfusion Reaction