NON-KARDİYAK CERRAHİ GİRİŞİM GEÇİREN PEDİATRİK HASTALARDA ERİTROSİT TRANSFÜZYONUNUN HASTA SONUÇLARINA ETKİSİ

Year 2022, , 727 - 738, 20.06.2022

Ayda Kebapçı , Pelin Karaçay

https://doi.org/10.33715/inonusaglik.1019410

Abstract

Non-kardiyak cerrahi girişim geçiren hastalarda eritrosit transfüzyonunun hasta sonuçlarına etkisini inceleyen çalışmaların sayısı oldukça sınırlıdır. Bu çalışmada amaç, non-kardiyak cerrahi girişim geçiren pediatrik hastalarda, eritrosit süspansiyonu (ES) transfüzyonunun hasta sonuçlarına etkisinin belirlenmesidir. Tanımlayıcı ve karşılaştırıcı nitelikte olan bu retrospektif çalışmaya, 2018-2020 yılında özel bir üniversite hastanesinde yatan, elektif non-kardiyak cerrahi girişim geçiren 144 çocuk hasta (ES uygulanan n=52; ES uygulanmayan n=92) dahil edildi. Verilerinin analizinde, tanımlayıcı istatistikler ve hasta sonuçlarının karşılaştırılmasında Mann-Whitney U testi kullanıldı. Çalışmada, hastaların taburculuk sırası hemoglobin (Hgb) düzeyi ve hastanede toplam kalış süreleri primer hasta sonucu ölçütleri olarak belirlendi. Her iki grup arasında taburculuk sırası bakılan Hgb değerleri (10.2 vs 10.8) arasında istatistiksel olarak anlamlı bir fark olmadığı belirlendi. Hastanede toplam yatış süreleri incelendiğinde ise; ES transfüzyonu uygulanan gruptaki hastaların hastanede yatış süresinin uygulanmayanlara göre (19.3 gün vs 6.2 gün) istatistiksel olarak anlamlı şekilde yüksek olduğu belirlendi (p<.01). Eritrosit transfüzyonu, non-kardiyak cerrahi girişim geçiren hastalarda hastanede kalış süresini uzattığını düşündürmüştür. Non-kardiyak cerrahi girişim geçiren pediatrik hastalara yönelik kısıtlayıcı transfüzyon stratejisinin kullanımına gereksinim vardır. Ayrıca multidisipliner ekip ve hemovijilans hemşireleri arasındaki iletişim arttırılarak ve hastaların klinik bulguları ve tanısı dikkate alınarak gereksiz transfüzyonu engelleyecek yaklaşımlar uygulanmalıdır.

Keywords

Cerrahi, Eritrosit Süspansiyonu, Non-Kardiyak, Pediatri, Transfüzyon

The Effect of Erythrocyte Transfusion on Pediatric Patient Outcomes in Non-Cardiac Surgery

Abstract

The number of studies examining the effect of erythrocyte transfusion on patient outcomes in patients undergoing non-cardiac surgery is very limited. This study aimed to determine the effect of erythrocyte transfusion on patient outcomes in pediatric patients undergoing non-cardiac surgery. This descriptive, comparative, and retrospective study included 144 pediatric patients who underwent elective, non-cardiac surgery in a private university hospital in 2018-2020. In the analysis of the data; the Mann-Whitney U test was applied to compare descriptive statistics and patient outcomes. In the study, the hemoglobin level at the discharged time of the patients and the total hospitalization time were determined as the primary patient outcome criteria. It was determined that there was no statistically significant difference between the two groups in terms of Hgb values (10.2 vs 10.8) at discharge (p > .01). When the hospitalization time was examined; it was determined that the hospitalization period (19.3 days) of the patients in the experimental group was statistically significantly higher than the control group (6.2 days) (p < .01). Erythrocyte transfusion increased hospitalization time in hospital of pediatric patients undergoing non-cardiac surgery. There is a need for the use of a restrictive transfusion strategy for pediatric patients undergoing non-cardiac surgery. In addition, approaches should be implemented to prevent unnecessary transfusions by increasing the communication between the multidisciplinary team and hemovigilance nurses and considering the clinical findings and diagnosis of patients.

Keywords

Erythrocyte suspension, Non-Cardiac, Pediatrics, Surgery, Transfusion

References

• Adogwa, O., Lilly, D. T., Khalid, S., Desai, S. A., Vuong, V. D., Davison, M. A., ...Cheng, J. (2019). Extended length of stay after lumbar spine surgery: sick patients, postoperative complications, or practice style differences among hospitals and physicians? World neurosurgery, 123, e734-e739.
• Aykut, G., Yürük, K. ve İnce, C. (2014). Eritrosit transfüzyonunda doku oksijenlenmesini etkileyen faktörler. Turkish Journal of Anesthesia & Reanimation, 42(3).
• Badke, C. M., Borrowman, J. A., Haymond, S., Rychlik, K. ve Malakooti, M. R. (2020). 7 Is the New 8: Improving adherence to restrictive PRBC transfusions in the pediatric ICU. The Journal for Healthcare Quality (JHQ), 42(1), 19-26.
• Baker, D. W., Qaseem, A., Reynolds, P. P., Gardner, L. A. ve Schneider, E. C. (2013). Design and use of performance measures to decrease low-value services and achieve cost-conscious care. Annals of internal medicine, 158(1), 55-59.
• Bateman, S. T., Lacroix, J., Boven, K., Forbes, P., Barton, R., Thomas, N. J., ...Randolph, A. G. (2008). Anemia, blood loss, and blood transfusions in North American children in the intensive care unit. American journal of respiratory and critical care medicine, 178(1), 26-33.
• Cholette, J. M., Rubenstein, J. S., Alfieris, G. M., Powers, K. S., Eaton, M. ve Lerner, N. B. (2011). Children with single-ventricle physiology do not benefit from higher hemoglobin levels post cavopulmonary connection: results of a prospective, randomized, controlled trial of a restrictive versus liberal red-cell transfusion strategy. Pediatric Critical Care Medicine, 12(1), 39-45.
• Cholette, J. M., Swartz, M. F., Rubenstein, J., Henrichs, K. F., Wang, H., Powers, K. S., ... Blumberg, N. (2017). Outcomes using a conservative versus liberal red blood cell transfusion strategy in infants requiring cardiac operation. The Annals of thoracic surgery, 103(1), 206-214.
• Chow, I., Purnell, C. A. ve Gosain, A. K. (2015). Assessing the impact of blood loss in cranial vault remodeling: a risk assessment model using the 2012 to 2013 pediatric national surgical quality improvement program data sets. Plastic and reconstructive surgery, 136(6), 1249-1260.
• Costello, J. M., Graham, D. A., Morrow, D. F., Potter-Bynoe, G., Sandora, T. J. ve Laussen, P. C. (2009). Risk factors for central line-associated bloodstream infection in a pediatric cardiac intensive care unit. Pediatric Critical Care Medicine, 10(4), 453-459.
• de Gast-Bakker, D. H., De Wilde, R. B. P., Hazekamp, M. G., Sojak, V., Zwaginga, J. J., Wolterbeek, R., ...Gesink-van der Veer, B. J. (2013). Safety and effects of two red blood cell transfusion strategies in pediatric cardiac surgery patients: a randomized controlled trial. Intensive Care Medicine, 39(11), 2011-2019.
• Downey, L. A. (2021). Patient blood management in pediatric anesthesiology. Current Anesthesiology Reports, 1-6.
• Elsamadicy, A. A., Koo, A. B., Kundishora, A. J., Chouairi, F., Lee, M., Hengartner, A. C., ...DiLuna, M. L. (2019). Impact of patient and hospital-level risk factors on extended length of stay following spinal fusion for adolescent idiopathic scoliosis. Journal of Neurosurgery: Pediatrics, 24(4), 469-475.
• Fernandez, P. G., Taicher, B. M., Goobie, S. M., Gangadharan, M., Homi, H. M., Kugler, J. A., ...Stricker, P. A. (2019). Predictors of transfusion outcomes in pediatric complex cranial vault reconstruction: a multicentre observational study from the Pediatric Craniofacial Collaborative Group. Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 66(5), 512-526.
• Gauvin, F., Robillard, P., Hume, H., Grenier, D., Whyte, R., Webert, K., …Delage, G. (2012). Transfusion-related acute lung injury in the Canadian paediatric population. Paediatrics & child health, 17, 235-239.
• Goobie, S. M., Gallagher, T., Gross, I. ve Shander, A. (2019). Society for the advancement of blood management administrative and clinical standards for patient blood management programs. (pediatric version). Pediatric Anesthesia, 29(3), 231-236.
• Goodnough, L. T., Maggio, P., Hadhazy, E., Shieh, L., Hernandez‐Boussard, T., Khari, P., …Shah, N. (2014). Restrictive blood transfusion practices are associated with improved patient outcomes. Transfusion, 54(10pt2), 2753-2759.
• Guzzetta, N. A., Allen, N. N., Wilson, E. C., Foster, G. S., Ehrlich, A. C. ve Miller, B. E. (2015). Excessive postoperative bleeding and outcomes in neonates undergoing cardiopulmonary bypass. Anesthesia & Analgesia, 120(2), 405-410.
• Iyengar, A., Scipione, C. N., Sheth, P., Ohye, R. G., Riegger, L., Bove, E. L., ...Hirsch-Romano, J. C. (2013). Association of complications with blood transfusions in pediatric cardiac surgery patients. The Annals of thoracic surgery, 96(3), 910-916.
• Joint COmmision International (JCI) (2021). Proceedings from the National Summit on Overuse- Joint COmmision International 2017. 10 Ekim 2021 tarihinde http://www.jointcommission.org/overuse_summit/ adresinden erişildi.
• Kartha, V. M., Jacobs, J. P., Vener, D. F., Hill, K. D., Goldenberg, N. A., Pasquali, S. K., ...Jacobs, M. L. (2018). National benchmarks for proportions of patients receiving blood transfusions during pediatric and congenital heart surgery: an analysis of the STS Congenital Heart Surgery Database. The Annals of thoracic surgery, 106(4), 1197-1203.
• Kipps, A. K., Wypij, D., Thiagarajan, R. R., Bacha, E. A. ve Newburger, J. W. (2011). Blood transfusion is associated with prolonged duration of mechanical ventilation in infants undergoing reparative cardiac surgery. Pediatric critical care medicine: a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 12(1), 52.
• Kloesel, B., Kovatsis, P. G., Faraoni, D., Young, V., Kim, H. B., Vakili, K., …Goobie, S. M. (2017). Incidence and predictors of massive bleeding in children undergoing liver transplantation: A single‐center retrospective analysis. Pediatric Anesthesia, 27(7), 718-725.
• Krell, R. W., Girotti, M. E. ve Dimick, J. B. (2014). Extended length of stay after surgery: complications, inefficient practice, or sick patients?. JAMA surgery, 149(8), 815-820.
• Lacroix, J., Hébert, P. C., Hutchison, J. S., Hume, H. A., Tucci, M., Ducruet, T., ...Peters, M. J. (2007). Transfusion strategies for patients in pediatric intensive care units. New England Journal of Medicine, 356(16), 1609-1619.
• Lipitz-Snyderman, A. ve Bach, P. B. (2013). Overuse of health care services: when less is more…more or less. JAMA internal medicine, 173(14), 1277-1278.
• Marik, P. E. ve Corwin, H. L. (2008). Efficacy of red blood cell transfusion in the critically ill: A systematic review of the literature. Critical care medicine, 36(9), 2667-2674.
• Murphy, G. J., Reeves, B. C., Rogers, C. A., Rizvi, S. I., Culliford, L. ve Angelini, G. D. (2007). Increased mortality, postoperative morbidity, and cost after red blood cell transfusion in patients having cardiac surgery. Circulation, 116(22), 2544-2552.
• New, H. V., Berryman, J., Bolton‐Maggs, P. H., Cantwell, C., Chalmers, E. A., Davies, T., ... British Committee for Standards in Haematology. (2016). Guidelines on transfusion for fetuses, neonates and older children. British journal of haematology, 175(5), 784-828.
• Porter, M. E. (2009). A strategy for health care reform—toward a value-based system. N Engl J Med, 361(2), 109-112.
• Redlin, M., Kukucka, M., Boettcher, W., Schoenfeld, H., Huebler, M., Kuppe, H., …Habazettl, H. (2013). Blood transfusion determines postoperative morbidity in pediatric cardiac surgery applying a comprehensive blood-sparing approach. The Journal of thoracic and cardiovascular surgery, 146(3), 537-542.
• Salvin, J. W., Scheurer, M. A., Laussen, P. C., Wypij, D., Polito, A., Bacha, E. A., ...Thiagarajan, R. R. (2011). Blood transfusion after pediatric cardiac surgery is associated with prolonged hospital stay. The Annals of thoracic surgery, 91(1), 204-210.
• Stricker, P. A., Shaw, T. L., Desouza, D. G., Hernandez, S. V., Bartlett, S. P., Friedman, D. F., ...Jobes, D. R. (2010). Blood loss, replacement, and associated morbidity in infants and children undergoing craniofacial surgery. Pediatric Anesthesia, 20(2), 150-159.
• Székely, A., Cserép, Z., Sápi, E., Breuer, T., Nagy, C. A., Vargha, P., …Treszl, A. (2009). Risks and predictors of blood transfusion in pediatric patients undergoing open heart operations. The Annals of thoracic surgery, 87(1), 187-197.
• Valentine, S. L., Bembea, M. M., Muszynski, J. A., Cholette, J. M., Doctor, A., Spinella, P. C., ...Bateman, S. T. (2018). Consensus recommendations for red blood cell transfusion practice in critically ill children from the pediatric critical care transfusion and anemia expertise initiative. Pediatric critical care medicine: A journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 19(9), 884.