Predictors of red cell transfusion in children and adolescents undergoing spinal fusion surgery

Study Design. A retrospective review was performed. Objective. To determine clinical predictors of allogeneic and autologous red cell transfusion in children and adolescents undergoing spinal fusion surgery. Summary of Background Data. Blood loss during spinal fusion surgery often results in the need for transfusion therapy. Preoperative identification of patients at increased risk for red cell transfusion would allow more specific use of interventions designed to control excessive bleeding. Methods. The medical records of all patients undergoing posterior spinal fusion surgery at a single institution between July 1, 1999 and June 30, 2001 were reviewed. Logistic and stepwise multiple regression analyses were used to identify predictors of allogeneic and autologous red cell transfusion during the operative and postoperative periods. Results. Posterior spinal fusion surgery was performed in 107 patients (males, 42%) with a median age of 13.7 years (range, 1-20 years). The median intraoperative blood loss was 22 mL/kg (range, 4.4-72 mL/kg). Blood transfusion involved 63 patients (59%) who received 17 mL/kg (range, 3-65 mL/kg) of allogeneic packed red blood cells and 14 patients (13%) who received 7 mL/kg (range, 4-19 mL/kg) of autologous red cells donated before surgery. Underlying neuromuscular disease, lower body weight, and a higher number of vertebrae fused independently predicted a greater number of allogeneic red cells transfused (R² = 0.53). The amount of autologous blood donated before surgery predicted the number of autologous red cells transfused (R² = 0.56). Conclusions. Allogeneic red cell transfusion often is required for small patients with underlying neuromuscular disease who undergo extensive spinal fusion surgery. These patients may be less able to donate autologous blood before surgery. Newer therapies to reduce blood loss and transfusion requirement are needed most for this population.