(P-PB-8) Blood Components Utilization in Pediatric Cardiac Surgeries at a Tertiary Care Freestanding Children's Hospital in India

Background/Case Studies: In India, there are estimated 240,000 annual births with congenital heart disease (CHD). Of these, nearly 20% require early surgical interventions. With an increasing adaptation of patient blood management (PBM) in cardiac surgery, there is a growing interest in pre-operative optimization and decreasing intra/post-operative allogeneic transfusion requirements. This study is a retrospective analysis of blood component utilization in pediatric cardiac surgeries at a newly established pediatric cardiac surgery department at a free-standing tertiary care pediatric hospital in India.

Study

Design/Methods: All pediatric (less than 18 years) cardiac surgery cases between 2018 to 2021 were included. There was intermittent cessation of services due to the COVID-19 pandemic. Data captured included the demographic description, primary diagnosis, type of surgery, estimated total blood loss, total blood utilization for the entire hospitalization since the surgery, blood components transfused, length of hospital stay and mortality.

Results/Findings: A total of 101 pediatric cardiac surgeries (M: F = 61:40) were included. Age distribution was as follows: < 1 year 25.7% (26/101), 1 to 5 years 38% (39/101) and 35.6% >5 years (36/101) with the youngest patient being 26 days old. Of these, 83.1% (84/101) were open-heart surgeries [acyanotic CHDs (n=46); cyanotic CHDs (n=34) & acquired CHDs (n=4)] and 16.8% (17/101) were closed-heart surgeries. The overall mean hospital stay was 6.5 ± 4.3 days. Mean intra-operative blood loss was higher in patients with mortality (n=27); 1074±2529 ml as compared to the rest of the patients 229±330 ml (p < 0.001).

Of the 101 surgeries, 6 did not need any transfusions. The remaining 95 surgeries utilized a total of 700 units of blood components (mean+-SD 7.3±5.3 units/surgery); with a significantly higher number of transfusions in open-heart pediatric surgeries (total 677 units; mean+-SD 8 ± 5.2units) as compared to closed-heart surgeries (total 23 units, 1.3+-1.5 units) p-value < 0.0001. Blood utilization was significantly higher during the post-operative phase (85.8% of all usage; 601/700 units; mean 5.3 ± 5.9 units per surgery) than intra-operatively (0.9 ± 1 units/surgery), p< 0.01 and in patients who died (n=27); total 439 units (mean 9.6 ± 8units/surgery) as compared to non-deceased patients (5.9 ± 3.7 units/surgery).

Conclusions: In this single institutional experience in pediatric cardiac surgeries, the transfusion requirement varied depending on the underlying CHD physiology and the type of surgery planned. There was a significant difference in transfusion requirements during different phases of the surgery (Intra versus post-operative) and the survival outcomes of the surgery.

Importance of research: This is one of the first detailed data on blood component utilization for pediatric cardiac surgeries from India. In this single institutional experience in pediatric cardiac surgeries, we identify transfusion requirement being highly dependent on the underlying CHD physiology and the type of surgery planned and the major peri-operative phases of blood transfusion requirements.