title: Predictive factors for homologous transfusion during paediatric scoliosis surgery.
abstract: BACKGROUND
  Blood saving strategies during paediatric spinal surgery often include recombinant erythropoietin (rEPO) and antifibrinolytic therapy (AFT). The goal of this study was to investigate additional preventive factors involved in the risk of blood transfusion.
  
  
  METHODS
  This prospective study was designed with the aim of identifying factors associated with the perioperative (defined as the intraoperative and the first postoperative day) probability of homologous red cell transfusion during scoliosis surgery in children operated during a one year period in our institution. The predictors analysed were: age, weight less than the 3rd percentile (W<3P), indication for spinal surgery (idiopathic or neuromuscular), Cobb's angle, ASA status, preoperative haemoglobin, number of levels fused, duration of surgery, intraoperative fluid intakes, sacral fusion and thoracoplasty. Statistical analyses were performed using a multivariate logistic regression model.
  
  
  RESULTS
  One hundred and forty-seven patients were included in the analysis. Multivariate analysis found the following variables to be independent predictors for an increased risk of homologous blood transfusion: W<3P, neuromuscular scoliosis and duration of surgery > 255 minutes. ROC analysis for the latter model found an area under the curve of 0.9 (95% confidence interval: 0.8-0.97). The accuracy of the model was 92.3% (97.4% for non-transfusion and 69.2% for transfusion). Multivariate sensitivity analysis excluding patients with no preoperative administration of EPO found similar results.
  
  
  CONCLUSIONS
  The current results indicate that optimising nutritional status might prevent allogenic blood transfusion and requires further investigation.
authors.affiliation: Department of Anaesthesia and Intensive care, Robert-Debré University Hospital, Paris, France; Paris Diderot University, Paris VII, PRES Paris Sorbonne Cité, Paris, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Dupuis
authors.affiliation: Department of Anaesthesia and Intensive care, Robert-Debré University Hospital, Paris, France; Paris Diderot University, Paris VII, PRES Paris Sorbonne Cité, Paris, France.
authors.forename: Daphné
authors.initials: D
authors.lastname: Michelet
authors.affiliation: Department of Anaesthesia and Intensive care, Robert-Debré University Hospital, Paris, France; Paris Diderot University, Paris VII, PRES Paris Sorbonne Cité, Paris, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Hilly
authors.affiliation: Department of Anaesthesia and Intensive care, Robert-Debré University Hospital, Paris, France; Paris Diderot University, Paris VII, PRES Paris Sorbonne Cité, Paris, France.
authors.forename: Thierno
authors.initials: T
authors.lastname: Diallo
authors.affiliation: Department of Paediatric Orthopaedic Surgery, Robert-Debré University Hospital, Paris, France; Paris Diderot University, Paris VII, PRES Paris Sorbonne Cité, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Vidal
authors.affiliation: Department of Pain Management, Robert-Debré University Hospital, Paris, France; Paris Descartes University, Paris V, PRES Paris Sorbonne Cité, Paris, France.
authors.forename: Honorine
authors.initials: H
authors.lastname: Delivet
authors.affiliation: Department of Anaesthesia and Intensive care, Robert-Debré University Hospital, Paris, France; Paris Diderot University, Paris VII, PRES Paris Sorbonne Cité, Paris, France; EA 7334 REMES, Paris Diderot University, Paris VII, PRES Paris Sorbonne Cité, Paris, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Nivoche
authors.affiliation: Department of Paediatric Orthopaedic Surgery, Robert-Debré University Hospital, Paris, France; Paris Diderot University, Paris VII, PRES Paris Sorbonne Cité, Paris, France.
authors.forename: Keyvan
authors.initials: K
authors.lastname: Mazda
authors.affiliation: Department of Anaesthesia and Intensive care, Robert-Debré University Hospital, Paris, France; Paris Diderot University, Paris VII, PRES Paris Sorbonne Cité, Paris, France; DHU PROTECT, Inserm U1141, Robert-Debré University Hospital, Paris, France. Electronic address: souhayl.dahmani@rdb.aphp.fr.
authors.forename: Souhayl
authors.initials: S
authors.lastname: Dahmani
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D017707:Erythrocyte Transfusion; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods*; D011182:Postoperative Care / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011336:Probability; D011446:Prospective Studies; D012372:ROC Curve; D012600:Scoliosis / Q000473:pathology / Q000601:surgery*; D013123:Spinal Fusion; D013131:Spine / Q000473:pathology / Q000601:surgery
chemical_list: D006454:Hemoglobins
keywords: Blood saving; Paediatric; Recombinant erythropoietin; Scoliosis; Transfusion