Introduction: Patients with neuromuscular spinal deformities have underlying diagnoses and co-morbidities that increase perioperative morbidity and mortality. The National Surgical Quality Improvement Program (NSQIP) identified our institution as an outlier in the domain of Major Blood Transfusion for Spinal Fusion/ Neuromuscular group of patients. After literature review, our QI project goal was to decrease the number of neuromuscular spine (NMS) surgery patients that receive >25ml/kg of either cell saver or red blood cell (RBC) transfusion. Methods: We convened a multidisciplinary group, at our quaternary children’s hospital, that met regularly from Jan- June ‘24 and reviewed data, literature, and guidelines, and created a Neuromuscular Spine Surgery Care Plan. All phases of care were addressed: Preoperatively- patients approved at an indications review meeting undergo robust screening with referral to subspecialists for peri-op recommendations and optimization as needed. Intraoperatively- We adopted a balanced transfusion strategy with early transfusion of fresh frozen plasma, cryoprecipitate, and platelets with lab monitoring. Postoperatively- transfusions are restricted to clinically significant bleeding, hemodynamic instability, or hemoglobin ≤7g/dL, with early correction of coagulopathy. Education on new care plan was rolled out across involved departments. The Department of Surgery periop services collected data for the institution, maintained NSQIP records, and distributed biannual NSQIP reports. Results: During a baseline period from Aug‘23 to June‘24, there were 26 NMS surgery patients with median cell saver or RBC transfusion volume of 12.8ml/kg. Eight received >25ml/kg with a median of 44.3ml/kg transfused. From July to Dec‘24, there were 19 patients with a median transfusion volume of 5.1ml/kg, with 1 outlier. From Jan- Jun’25, median transfusion volume dropped to 3ml/kg with no outliers. Conclusions: A collaborative, multidisciplinary approach to optimizing patients before surgery, targeting balanced transfusions intra-operatively, correcting coagulopathy and targeting lower transfusion thresholds of 7g/dl in stable patients postoperatively, led to a decrease in blood product exposure for pediatric patients undergoing neuromuscular spine surgery.
Pinto et al. (Sun,) studied this question.