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S26-16
(P)
PERIOPERATIVE TRANSFUSION RISK IN CLASSIC BLADDER EXSTROPHY
CLOSURE: RESULTS FROM A NATIONAL DATABASE REVIEW
Janae PREECE
1
, Lindsey ASTI
2
and Daryl MCLEOD
3
1) Nationwide Children's Hospital, Urology, Columbus, USA - 2) Nationwide Children's Hospital, Center for Surgical
Outcomes Research, Columbus, USA - 3) Nationwide Children's Hospital, Urology, Center for Surgical Outcomes
Research, Columbus, USA
PURPOSE
Blood transfusions have known risks, and emerging evidence suggests systemic immunomodulatory effects from
transfusion. We sought to determine risk factors for perioperative transfusion in patients undergoing closure for classic
bladder exstrophy (CBE).
MATERIAL AND METHODS
Patients undergoing CBE closure between 2012 and 2013 were identified by Current Procedure Terminology codes from
The National Surgical Quality Improvement Program Pediatric database, which encompasses 61 participating hospitals.
Patient demographics, comorbidities, and operative characteristics were analyzed for associations with transfusion
requirement intraoperatively or in the first 72 hours postoperatively.
RESULTS
Fifty-eight patients met our criteria. Thirty-four patients (58.6%) underwent transfusion. Patients who underwent
transfusion were more likely to be over three days of age than those who did not (94.1% versus 74.8%; p=0.026).
Transfused patients were also more likely than those not transfused to have undergone osteotomy, (82.4% versus
54.2%; p=0.020), had an external fixation (47.1% versus 8.3%; p=0.002), had longer median operative times (446
versus 324 minutes; p<0.001), and had longer average postoperative lengths of stay (LOS) (40 versus 18 days;
p=0.019).
CONCLUSIONS
A significant number of patients undergoing CBE closure required transfusion in the perioperative period (58.6%),
increasing to 82.4% in patients undergoing osteotomies. Further risk factors for transfusion (external fixation, increased
operative times, and longer LOS) may also be related to osteotomy. In light of the risks associated with transfusion, our
data adds to the ongoing debate regarding osteotomy in CBE closure and emphasizes the need for proper family
counseling to address this concern at the time of surgical planning.