Risk factors of intraoperative blood loss and transfusion for pediatric patients undergoing brain tumor removal: a retrospective cohort study

OBJECTIVE Intraoperative blood loss is a major challenge in pediatric brain tumor removal. Several clinical and surgi-cal factors may influence the occurrence of intraoperative blood loss and blood transfusion. This study aimed to identify the risk factors of intraoperative blood loss and intraoperative red blood cell (RBC) transfusion for pediatric patients undergoing brain tumor removal.METHODS A total of 297 pediatric patients undergoing brain tumor removal were selected in this retrospective, single -center study. Demographic data, laboratory data, imaging data, and surgical records were collected, and then inde-pendent risk factors for intraoperative blood loss and transfusion were identified using multivariate stepwise regression analysis.RESULTS The median intraoperative blood loss in our cohort was 23.1 ml/kg (IQR 10.0-60.0 ml/kg). In total, 284 (95.6%) patients received intraoperative RBC transfusion, with a median amount of 0.2 U/kg (IQR 0.0-2.6 U/kg). Age (0 = -0.189; 95% CI [-1.359, -0.473]; p < 0.001); preoperative hemoglobin level (0 = -0.141; 95% CI [-1.528, -0.332]; p = 0.003); anesthesia time (0 = 0.189; 95% CI [0.098, 0.302]; p < 0.001); unclear tumor boundary (0 = 0.100; 95% CI [2.067, 41.053]; p = 0.031); tumor size (0 = 0.390; 95% CI [14.706, 24.342]; p < 0.001); and intraoperative continuous infusion of vasopressor (0 = 0.155; 95% CI [13.364, 52.400]; p = 0.001) were independent predictors of intraoperative blood loss. Independent predictors of the need for RBC transfusion included age (0 = -0.268; 95% CI [-0.007, -0.004]; p < 0.001); preoperative hemoglobin level (0 = -0.117; 95% CI [-0.005, -0.001]; p = 0.003); anesthesia time (0 = 0.221; 95% CI [0.001, 0.001]; p < 0.001); unclear tumor boundary (0 = 0.110; 95% CI [0.024, 0.167]; p = 0.010); tumor size (0 = 0.370; 95% CI [0.056, 0.092]; p < 0.001); intraoperative continuous infusion of vasopressor (0 = 0.157; 95% CI [0.062, 0.205]; p < 0.001); and tumor grade (0 = 0.107; 95% CI [0.007, 0.062]; p = 0.014).CONCLUSIONS Overall, age, preoperative hemoglobin, tumor size, anesthesia time, continuous infusion of vasopres-sors, and unclear tumor boundary were the main determinants for intraoperative blood loss and RBC transfusion in pediatric patients undergoing brain tumor removal.