Risk factors of intraoperative blood loss and transfusion for pediatric patients undergoing brain tumor removal: a retrospective cohort study

医学 回顾性队列研究 输血 麻醉 外科 队列研究 失血 内科学
作者
Na Zhang,Yingyi Xu,Xinke Xu,Cheng Chen,Yubing Guo,Yonghong Tan
出处
期刊:Journal of neurosurgery [Journal of Neurosurgery Publishing Group]
卷期号:31 (4): 290-297 被引量:6
标识
DOI:10.3171/2022.12.peds22252
摘要

OBJECTIVE Intraoperative blood loss is a major challenge in pediatric brain tumor removal. Several clinical and surgical factors may influence the occurrence of intraoperative blood loss and blood transfusion. This study aimed to identify the risk factors of intraoperative blood loss and intraoperative red blood cell (RBC) transfusion for pediatric patients undergoing brain tumor removal. METHODS A total of 297 pediatric patients undergoing brain tumor removal were selected in this retrospective, singlecenter study. Demographic data, laboratory data, imaging data, and surgical records were collected, and then independent risk factors for intraoperative blood loss and transfusion were identified using multivariate stepwise regression analysis. RESULTS The median intraoperative blood loss in our cohort was 23.1 ml/kg (IQR 10.0–60.0 ml/kg). In total, 284 (95.6%) patients received intraoperative RBC transfusion, with a median amount of 0.2 U/kg (IQR 0.0–2.6 U/kg). Age (β = −0.189; 95% CI [−1.359, −0.473]; p < 0.001); preoperative hemoglobin level (β = −0.141; 95% CI [−1.528, −0.332]; p = 0.003); anesthesia time (β = 0.189; 95% CI [0.098, 0.302]; p < 0.001); unclear tumor boundary (β = 0.100; 95% CI [2.067, 41.053]; p = 0.031); tumor size (β = 0.390; 95% CI [14.706, 24.342]; p < 0.001); and intraoperative continuous infusion of vasopressor (β = 0.155; 95% CI [13.364, 52.400]; p = 0.001) were independent predictors of intraoperative blood loss. Independent predictors of the need for RBC transfusion included age (β = −0.268; 95% CI [−0.007, −0.004]; p < 0.001); preoperative hemoglobin level (β = −0.117; 95% CI [−0.005, −0.001]; p = 0.003); anesthesia time (β = 0.221; 95% CI [0.001, 0.001]; p < 0.001); unclear tumor boundary (β = 0.110; 95% CI [0.024, 0.167]; p = 0.010); tumor size (β = 0.370; 95% CI [0.056, 0.092]; p < 0.001); intraoperative continuous infusion of vasopressor (β = 0.157; 95% CI [0.062, 0.205]; p < 0.001); and tumor grade (β = 0.107; 95% CI [0.007, 0.062]; p = 0.014). CONCLUSIONS Overall, age, preoperative hemoglobin, tumor size, anesthesia time, continuous infusion of vasopressors, and unclear tumor boundary were the main determinants for intraoperative blood loss and RBC transfusion in pediatric patients undergoing brain tumor removal. Clinical trial registration no.: ChiCTR1900024803 ( ChiCTR.org )
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