Perioperative blood transfusion and complications in children undergoing surgery for solid tumors

Background The objective was to assess whether perioperative blood transfusion (PBT) is associated with postoperative complications in children undergoing surgery for a solid tumor. Methods Using 2012-2014 National Surgical Quality Improvement Program Pediatric data, we identified patients aged 0-18 years who underwent surgery (biopsy or resection) for solid tumors. We compared demographic, clinical, and 30-day outcome characteristics between children who did and did not receive a PBT within 72 hours after surgery. Propensity score–matched analyses were used to estimate the effect of PBT on postoperative complications, in the overall cohort, the subgroup undergoing resection, and the subgroup with liver tumors. Results Of 961 patients who underwent surgery for solid tumors, 27.8% required PBT. Patients requiring PBT were more likely to have preoperative risk factors, including ventilator dependence, hematologic disorders, chemotherapy, sepsis, transfusion before surgery, and an American Society of Anesthesiologists class ≥3 (all P ≤ 0.01). In propensity score–matched analyses, PBT was not associated with overall complication risk (odds ratio [OR]: 1.50, P = 0.07) but was associated with an increased risk of postoperative mechanical ventilation (OR: 3.78, P < 0.001). Of the 750 patients undergoing tumor resection, 36.3% required PBT. After propensity matching, PBT was associated with overall postoperative complications (OR: 1.76, P = 0.02). Of 163 patients with liver tumors, 52.8% required PBT. After propensity matching, PBT was not associated with postoperative complications (OR: 2.00, P = 0.09). PBT was associated with a longer postoperative length of stay in all three analyses (all P < 0.01). Conclusions PBT was associated with higher risks for postoperative complications in children undergoing surgery for solid tumors.