Predictors and Outcomes of Perioperative Blood Transfusions in Classic Bladder Exstrophy Repair: A Single Institution Study
Mahir Maruf, M.D., John Jayman, B.A., Daniel Friedlander, M.D., Matthew Kasprenski, M.D., Timothy Baumgartner, M.D., Heather Di Carlo, M.D., John P. Gearhart, M.D..
Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD, USA.
BACKGROUND: The primary bladder closure of classic bladder exstrophy (CBE) is a major operation that occasionally requires intra-operative or post-operative (72 hours) blood transfusions. This study reports the perioperative transfusion rate, risk factors for transfusion and outcomes from a high volume exstrophy-epispadias center in the primary bladder closure of CBE patients.
METHODS: A prospectively-maintained institutional exstrophy-epispadias complex database of 1300 patients was reviewed for primary CBE closures performed at a single institution from 1975 to 2017. Patient and surgical factors were analyzed to determine transfusion rates, risk factors for transfusions, and outcomes. The patients were subdivided into 2 groups, based upon time of closure. Neonatal closure is defined as those closed prior to 1-month of age, whereas delayed closure is defined as those greater than 1-month of age.
RESULTS: 184 CBE patients underwent primary bladder closure, of which 158 patients had a complete medical record available for review and analysis. 106 patients were closed in the neonatal period and 52 were delayed closures. In total, 46 (29%) patients received a peri-operative transfusion. 25 transfusions were in the neonatal closure group, yielding a transfusion rate of 24%. In comparison, 21 patients were transfused in the delayed closure group, a transfusion rate of 40%. There was no difference in transfusion rates for sex and race. The average operative time was higher in transfused patients (499 vs 400 minutes; p=0.018). Similarly, the median length of stay was also higher in transfused patients (39 vs 35 days; p=0.011). In multivariate logistic regression, only osteotomy remained an independent predictor of receiving a transfusion, increasing the odds by 200% (OR, 3.0; 95% CI 1.2-8.0; p=0.020). No adverse transfusion reactions or complications were observed. CONCLUSIONS: Nearly one-third of CBE patients undergoing primary closure at a single institution received a perioperative blood transfusion. While there was an association between transfusions and delayed primary closure, pelvic osteotomy, increased operative time, and increased length of stay; only the use of pelvic osteotomy independently increased the odds of receiving a transfusion.
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