Prevalence of preoperative anemia in pediatric surgical patients and its impact on perioperative blood transfusion

Abstract

Aim: To determine the prevalence of preoperative anemia in children presenting for surgery at our institution and to establish whether preoperative anemia increased the likelihood of perioperative transfusion. Methods: A retrospective review of all noncardiac surgical patients over a 2-week period. Data were collected for demographics, type of surgery, hemoglobin concentration within 28 days of surgery, severity of anemia and whether a blood transfusion was administered within 28 days of surgery. Results: 723 patients underwent non-cardiac surgery during the study period, of which 334 had a preoperative hemoglobin measurement, 116 of those were anemic. Blood transfusion was administered in 19.9% of all anemic patients, compared to 5.4% of non-anemic patients (odd ratio [OR] 4.383; 95% confidence interval [CI], 2.10–9.53; p less than 0.0001). In anemic children over six months of age, 75.3% were of moderate severity, 22.6% were mild, and 2.1% severe, with transfusion rates being similar 23.6, 15.1, and 33.0%, respectively. The prevalence of anemia increased with ASA severity with blood transfusion occurring more often in anemic than non-anemic patients in all ASA grades. Anemic patients who underwent intermediate or major procedures were significantly more likely to be transfused than their non-anemic counterparts, with no significant difference seen for minor procedures. Conclusion: Preoperative anemia is common in children presenting for surgery at our institution and in the majority of cases, this is of moderate severity. Preoperative anemia is associated with an increased likelihood of perioperative blood transfusion compared to patients with hemoglobin concentrations within the normal range.