P61. Allogenic transfusion increases the risk for postoperative infectious complications in children undergoing spinal fusion

Abstract

<h3>BACKGROUND CONTEXT</h3> Perioperative transfusion is thought to contribute to infectious complications in adolescent spinal fusion procedures, though low power, inconsistent findings, and uncontrolled potential confounders limit interpretation of the literature to date. <h3>PURPOSE</h3> Perioperative allogenic RBC transfusion is associated with 30-day postoperative infectious complications in pediatric spinal fusion patients. <h3>STUDY DESIGN/SETTING</h3> Retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program Pediatric (ACS-NSQIP) database. <h3>PATIENT SAMPLE</h3> A total of 19,132 pediatric patients from the ACS-NSQIP database. <h3>OUTCOME MEASURES</h3> Postoperative infections. <h3>METHODS</h3> The multicenter NSQIP pediatric surgical database was queried for spinal fusion procedures in patients <18 years, from 2016-2019. Perioperative allogenic blood transfusion was defined as any transfusion of red blood cells (RBCs) from surgery start until 72h postoperative. Postoperative complications included surgical site infection (SSI), pneumonia (PNA), urinary tract infection (UTI), systemic sepsis, or septic shock up to 30 days postoperative. Logistic regression was performed comparing those who did and did not experience infectious complications. <h3>RESULTS</h3> Of 19,132 children undergoing spinal fusion, 693 (3.6%) patients. experienced ≥1 infectious complication postop: 393 (2.0%) with SSI, 192 (1.0%) with PNA, 155 (0.6%) with UTI, 120 (0.6%) with systemic sepsis, and 29 (0.2%) with septic shock. 4075 (21.3%) were transfused allogenic RBCs. In multiple logistic regression, after adjusting for comorbid conditions, periop RBC transfusion was independently associated with experiencing ≥1 infectious complication (OR 1.54, 95%CI 1.26-1.87), SSI (OR 1.35, 95%CI 1.04-1.75) and PNA (OR 1.91, 95%CI 1.34-2.72). In addition, age (OR 0.92, p<0.0001), weight (OR 1.01, p=0.0009), ASA status (OR 2.73 p<0.0001), neuromuscular disease (OR 1.83 p<0.0001), operative time >300 minutes (OR 1.35 p=0.0017), 13 or more levels fused (OR 1.67 p<0.0001), and antibiotic treatment of the surgical site (OR 0.75, p=0.0102), were also independently associated with infectious complications. <h3>CONCLUSIONS</h3> This is the largest cohort to date examining infectious outcomes following pediatric spinal fusion surgery, providing evidence for the association between transfusion and postoperative infections. After adjusting for patient and procedure-specific characteristics, transfusion increased the odds of any postoperative infection by 54%, SSI by 35%, and pneumonia by 91%. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.