Risk factors for perioperative mortality and transfusion in sacrococcygeal teratoma resections

Summary Background Sacrococcygeal teratomas are a common congenital tumor. Surgical resection can occur in utero, in the neonatal period, or in the postneonatal period. Aims We describe patient and tumor factors associated with mortality and transfusion in this population. Methods We did a retrospec...

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Bibliographic Details
Published in:Pediatric anesthesia 2017-07, Vol.27 (7), p.726-732
Main Authors: Isserman, Rebecca S., Nelson, Olivia, Tran, Kha M., Cai, Lingyu, Polansky, Marcia, Rosenbloom, Julia M., Goebel, Theodora K., Lin, Elaina E., Veyckemans, Francis
Format: Article
Language:English
Subjects:
Age
Blood Transfusion - statistics & numerical data
Female
fetal surgery
Humans
hydrops fetalis
Infant
Infant, Newborn
Infant, Premature
Intraoperative Period
Male
massive transfusion
Morphology
Mortality
neonatal surgery
outcomes
Perioperative Period - mortality
Postoperative Period
Retrospective Studies
Risk Factors
Sacrococcygeal Region
sacrococcygeal teratoma
Spinal Neoplasms - congenital
Spinal Neoplasms - mortality
Spinal Neoplasms - surgery
Survival Analysis
Teratoma - congenital
Teratoma - mortality
Teratoma - surgery
Tumors
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Summary:Summary Background Sacrococcygeal teratomas are a common congenital tumor. Surgical resection can occur in utero, in the neonatal period, or in the postneonatal period. Aims We describe patient and tumor factors associated with mortality and transfusion in this population. Methods We did a retrospective chart review of patients who underwent sacrococcygeal teratoma resection between January 1998 and March 2016. Demographic data, transfusion data, and tumor characteristics were collected. Descriptive statistics were calculated, and univariate comparisons were performed with chi‐square test and Fisher's exact test. Variables significant at univariate level were used in multivariate logistic regression and negative binomial regression. Results Of the 112 cases, 6 were in utero repairs, 73 were neonatal repairs, and 33 were repairs at >30 days of life. There was 17%, 1%, and 0% intraoperative mortality and 33%, 5%, and 0% 30‐day mortality in the in utero, neonatal, and >30 days of life repairs, respectively. All six patients who died within the first 30 days of life had a postmenstrual age of 30 weeks was associated with decreased intraoperative death (0% vs 10%; modified maximum likelihood estimate of OR 0.05; 95% CI 0.002–0.96; P = 0.02). Gestational age >30 weeks (2.4% vs 13.8%; OR 0.15; 95% CI 0.03–0.89; P = 0.04) and cystic morphology (0% vs 9.2%; modified maximum likelihood estimate of OR 0.1; CI 0.01–1.75; P = 0.04) were associated with decreased 30‐day mortality and emergent surgery (17.9% vs 1.2%; OR 18; 95% CI 2–162.2; P = 0.004) was associated with increased 30‐day mortality. Gestational age >30 weeks (33.7% vs 62.1%; OR 0.27; 95% CI 0.09–0.79; P = 0.02) and Altman class 3–4 (12.1% vs 52.7%; OR 0.1; 95% CI 0.03–0.34; P = 0.0002) were associated with decreased need for transfusion and noncystic tumor was associated with increased transfusion volume (131.6 ml·kg−1 [95% CI 94–184] vs 63 ml·kg−1 [95% CI 40–100.1]; P = 0.01). Conclusions Prematurity is associated with increased intraoperative and 30‐day mortality. Noncystic tumor morphology was the only significant factor associated with transfusion volume and all six patients who died had transfusion volumes of 240 ml·kg−1 or greater. In these patients at high risk of mortality due to blo
ISSN:1155-5645
1460-9592
DOI:10.1111/pan.13143