Factors Associated with Allogenic Blood Transfusion After Reconstructive Hip Surgery in Patients with Cerebral Palsy

Persistent Link:
http://hdl.handle.net/10150/603585
Title:
Factors Associated with Allogenic Blood Transfusion After Reconstructive Hip Surgery in Patients with Cerebral Palsy
Author:
Arthur, Jaymeson
Affiliation:
The University of Arizona College of Medicine - Phoenix
Issue Date:
23-Mar-2016
Rights:
Copyright © is held by the author. Digital access to this material is made possible by the College of Medicine - Phoenix, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
Collection Information:
This item is part of the College of Medicine - Phoenix Scholarly Projects 2016 collection. For more information, contact the Phoenix Biomedical Campus Library at pbc-library@email.arizona.edu.
Publisher:
The University of Arizona.
Abstract:
Background: The hip joint tends to be highly affected in patients with Cerebral Palsy (CP). Subluxation, problems with ambulation, posture, perineal hygiene, and pain can result. Severe cases often require corrective surgery of the affected dysplastic hip(s). This often is accomplished with varus derotational osteotomy (VDRO), femoral osteotomy, pelvic osteotomy, tendon releases/lengthening, or a combination of any of these procedures. These reconstructive hip surgeries can result in marked blood loss. Due to the highly vascularized nature of bone, surgery can result in marked blood loss. This increases the transfusion burden on the patient and increases exposure to blood products and the associated risks therein. By identifying the risk factors that contribute to intraoperative and postoperative blood loss, targeted strategies may be developed to reduce this risk to the patient. Aims: The purpose of this study is to provide descriptive analysis of the pediatric CP population undergoing corrective hip surgery. We will attempt to identify various risk factors that may predispose patients to significant blood loss during reconstructive hip surgery. This study will be the largest study analyzing blood management therapy with the VDRO procedure. Methods: This is a retrospective chart review of consecutive CP patients who have undergone reconstructive hip surgery at a single institution from 2000 to 2012. Demographic data to be analyzed includes patient age, gender, race/ethnicity, height, weight, BMI, and medical comorbidities. Also, type of procedure performed, bilateral vs unilateral reconstruction, specific diagnosis, preoperative hemoglobin and hematocrit (H and H), pre‐transfusion H and H, estimated blood loss (EBL), total operative time, cell saver volume, units transfused, complications, quantity of postoperative transfusion, and post‐transfusion H and H was recorded. Data was compared using the Chi‐squared method, or non‐parametric analog, to assess the likelihood of the need for postop transfusions as an initial univariate analyses. Results: 87 patients were included in the study. There was no significant relationship between the use of autologous blood and age, gender, weight, height, or BMI. Patients who received autologous blood also had a higher EBL (p=0.029) and were more likely to need allogenic transfusion (p=0.023). Concomitant DEGA procedure carried a 2.25 times relative risk of needing blood transfusion (p<0.001, 95% CI 1.402‐3.611). Bilateral VDRO was 1.64 times more likely to need a transfusion, however this was not quite statistically significant (p=0.052, 95% CI 0.972‐2.756) Conclusion: Varus derotational osteotomy for the correction of neuromuscular hip dysplasia can be associated with excessive blood loss, especially in the CP patient population. The use of autologous vs allogenic blood products carries various risks and benefits. This paper has identified that the need of concomitant DEGA osteotomy is correlated with increased blood loss. Also, the use of autologous blood product is correlated with increased blood loss.
Keywords:
Allogenic Blood Transfusion; Hip Surgery
MeSH Subjects:
Blood Transfusion; Cerebral Palsy
Description:
A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.titleFactors Associated with Allogenic Blood Transfusion After Reconstructive Hip Surgery in Patients with Cerebral Palsyen_US
dc.contributor.authorArthur, Jaymesonen
dc.contributor.departmentThe University of Arizona College of Medicine - Phoenixen
dc.date.issued2016-03-23en
dc.rightsCopyright © is held by the author. Digital access to this material is made possible by the College of Medicine - Phoenix, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.en_US
dc.description.collectioninformationThis item is part of the College of Medicine - Phoenix Scholarly Projects 2016 collection. For more information, contact the Phoenix Biomedical Campus Library at pbc-library@email.arizona.edu.en_US
dc.publisherThe University of Arizona.en
dc.description.abstractBackground: The hip joint tends to be highly affected in patients with Cerebral Palsy (CP). Subluxation, problems with ambulation, posture, perineal hygiene, and pain can result. Severe cases often require corrective surgery of the affected dysplastic hip(s). This often is accomplished with varus derotational osteotomy (VDRO), femoral osteotomy, pelvic osteotomy, tendon releases/lengthening, or a combination of any of these procedures. These reconstructive hip surgeries can result in marked blood loss. Due to the highly vascularized nature of bone, surgery can result in marked blood loss. This increases the transfusion burden on the patient and increases exposure to blood products and the associated risks therein. By identifying the risk factors that contribute to intraoperative and postoperative blood loss, targeted strategies may be developed to reduce this risk to the patient. Aims: The purpose of this study is to provide descriptive analysis of the pediatric CP population undergoing corrective hip surgery. We will attempt to identify various risk factors that may predispose patients to significant blood loss during reconstructive hip surgery. This study will be the largest study analyzing blood management therapy with the VDRO procedure. Methods: This is a retrospective chart review of consecutive CP patients who have undergone reconstructive hip surgery at a single institution from 2000 to 2012. Demographic data to be analyzed includes patient age, gender, race/ethnicity, height, weight, BMI, and medical comorbidities. Also, type of procedure performed, bilateral vs unilateral reconstruction, specific diagnosis, preoperative hemoglobin and hematocrit (H and H), pre‐transfusion H and H, estimated blood loss (EBL), total operative time, cell saver volume, units transfused, complications, quantity of postoperative transfusion, and post‐transfusion H and H was recorded. Data was compared using the Chi‐squared method, or non‐parametric analog, to assess the likelihood of the need for postop transfusions as an initial univariate analyses. Results: 87 patients were included in the study. There was no significant relationship between the use of autologous blood and age, gender, weight, height, or BMI. Patients who received autologous blood also had a higher EBL (p=0.029) and were more likely to need allogenic transfusion (p=0.023). Concomitant DEGA procedure carried a 2.25 times relative risk of needing blood transfusion (p<0.001, 95% CI 1.402‐3.611). Bilateral VDRO was 1.64 times more likely to need a transfusion, however this was not quite statistically significant (p=0.052, 95% CI 0.972‐2.756) Conclusion: Varus derotational osteotomy for the correction of neuromuscular hip dysplasia can be associated with excessive blood loss, especially in the CP patient population. The use of autologous vs allogenic blood products carries various risks and benefits. This paper has identified that the need of concomitant DEGA osteotomy is correlated with increased blood loss. Also, the use of autologous blood product is correlated with increased blood loss.en
dc.typeThesisen
dc.subjectAllogenic Blood Transfusionen
dc.subjectHip Surgeryen
dc.subject.meshBlood Transfusionen
dc.subject.meshCerebral Palsyen
dc.descriptionA Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.en
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