title: The indication for perioperative red blood cell transfusions is a predictive risk factor for severe postoperative morbidity and mortality in children undergoing cardiac surgery.
abstract: OBJECTIVE
  In paediatric cardiac surgery, red blood cell (RBC) transfusions are given to treat haemorrhage or to increase oxygen delivery (therapeutic transfusion). Sometimes, RBCs are added to the prime solution to avoid a too low haematocrit on bypass (CPB-driven transfusion). Our study investigated whether the reason for RBC transfusion might affect severe postoperative morbidity or mortality.
  
  
  METHODS
  This retrospective cohort study was conducted in a tertiary care level, children's hospital. The charts of all patients admitted between 2006 and 2009 were reviewed. Among transfused patients, children receiving a therapeutic transfusion were compared with those receiving a CPB-driven transfusion. The primary outcome was severe postoperative morbidity or mortality. Statistically significant variables founded with univariate analysis were incorporated in the multivariable logistic regression analysis to build a model that predicts severe postoperative morbidity or mortality. This model was then adjusted for clinically relevant variables that may interfere with 'indication for transfusion'.
  
  
  RESULTS
  One hundred and one (48%) patients in the therapeutic and 92 (26%) patients in the CPB-driven transfusion group developed severe postoperative morbidity or died (P < 0.001). A multivariable logistic regression showed that weight, ASA, calculated blood loss, intraoperative fluid balance, duration of CPB time and the indication group for transfusion [1.64 (1.03-2.62); P = 0.039] were independent risk factors for severe postoperative morbidity or mortality. The indication group for transfusion remained significant [2.0 (1.16-3.45); P = 0.013] after adjustment for significant predictors of indication for transfusion. Number of patients with infections, or neurological deficit, and length of mechanical ventilation, PICU and hospital length of stay, were significantly higher in the therapeutic compared with the CPB-driven transfusion group one.
  
  
  CONCLUSIONS
  The indication group for transfusion has an impact on the occurrence of severe postoperative morbidity or mortality in children undergoing cardiac surgery.
authors.affiliation: Paediatric Intensive Care Unit, Department of Paediatrics, University Children's Hospital Queen Fabiola, Brussels, Belgium ariane.willems@huderf.be.
authors.forename: Ariane
authors.initials: A
authors.lastname: Willems
authors.affiliation: Department of Anaesthesiology, University Hospital Brugmann, Brussels, Belgium Department of Anaesthesiology, University Children's Hospital Queen Fabiola, Brussels, Belgium.
authors.forename: Céline
authors.initials: C
authors.lastname: Van Lerberghe
authors.affiliation: Department of Anaesthesiology, University Hospital Brugmann, Brussels, Belgium Department of Anaesthesiology, University Children's Hospital Queen Fabiola, Brussels, Belgium.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Gonsette
authors.affiliation: Department of Anaesthesiology, University Hospital Brugmann, Brussels, Belgium Department of Anaesthesiology, University Children's Hospital Queen Fabiola, Brussels, Belgium.
authors.forename: Andrée
authors.initials: A
authors.lastname: De Villé
authors.affiliation: Emergency Department, University Hospital Erasme, Brussels, Belgium.
authors.forename: Christian
authors.initials: C
authors.lastname: Melot
authors.affiliation: Department of Anaesthesiology, Notre-Dame Hospital, Centre Hospitalier de l'Université de Montréal, Québec, Canada.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Hardy
authors.affiliation: Department of Anaesthesiology, University Hospital Brugmann, Brussels, Belgium Department of Anaesthesiology, University Children's Hospital Queen Fabiola, Brussels, Belgium.
authors.forename: Philippe
authors.initials: P
authors.lastname: Van der Linden
mesh_terms: D000293:Adolescent; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods / Q000401:mortality* / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data*; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D009017:Morbidity; D059035:Perioperative Period; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D006454:Hemoglobins
keywords: Cardiac surgery; Outcome; Paediatric; Red blood cell; Transfusion