An assessment of blood transfusion practices in high-risk paediatric surgeries in an Australian tertiary children's hospital

Abstract

Background: Excessive perioperative ordering of blood products, without corresponding need for transfusion, leads to increased costs and unnecessarily holds blood products which may be needed elsewhere. Implementation of a maximum surgical blood ordering schedule (MSBOS) can optimise usage of blood products and in turn, save time and resources associated with inappropriate blood ordering. High-risk paediatric procedures is one area in which the development of MSBOS could lead to significant benefits in these practices Aim: In this study, we assess blood ordering patterns in high-risk orthopaedics, plastics and neurosurgical procedures at a paediatric hospital in QLD to assess the need for MSBOS. Method: In this retrospective study, elective high-risk procedures done at Queensland Children's Hospital (QCH) from January 1, 2022 to 4 December 2024 were assessed. These included orthopaedic procedures (posterior spinal instrumentation, osteotomy of distal/ proximal femur with/without internal fixation, open reduction of femoral fracture with/without internal fixation), plastics procedures (cranioplasty) and neurosurgery procedures (lobectomy, craniotomy and excision of neoplasm of brain). Data collected consisted of number of units of blood crossmatched and number of units transfused for each procedure. These numbers were used to calculate crossmatch to transfusion ratio (CTR) and transfusion percentage (TP). Results: 397 procedures were included in this study with 173 orthopaedics procedures, 126 plastic procedures, and 98 neurosurgery procedures. The overall CTR and TP for orthopaedics, plastics and neurosurgery procedures included were 1.52 and 66%, 1.73 and 58%, 2.52 and 40% respectively. Summary/Conclusions: The development of a MSBOS schema can reduce costs and wastage associated with unnecessary blood ordering. High risk elective procedures in orthopaedics, plastics and neurosurgery could benefit from MSBOS guided blood ordering.