Development of a prediction model for allogenic blood transfusion in children undergoing surgery for developmental dysplasia of the hip

BACKGROUND: Blood transfusion is a common practice, but it is not without cost and risk. A model that predicts the risk of blood transfusion could guide informed preoperative blood ordering and use of blood loss preventive measures. OBJECTIVE: This study aimed to develop a prediction model of blood transfusion in children with developmental dysplasia of the hip (DDH) undergoing surgery. METHODS: A retrospective cohort of DDH patients from 2008 to 2017. The included patients were between 1 to 9 years old, underwent anterior open reduction and/or acetabular osteotomy with and without femoral shortening. The unit of analysis was undergoing such an operation. The outcome was allogenic blood transfusion. Potential predictors were age, sex, body mass index (BMI), international hip dysplasia institute grade, type of surgery, intervention bilaterally during the same operative session, primary versus reoperation surgery, the addition of regional anaesthesia, preoperative haemoglobin and hematocrit. RESULTS: A total of 524 patients who met the inclusion criteria underwent 721 operative sessions. The median age (interquartile range) at operation was 23 (20-33) months. The blood transfusion rate was 11.8%. Independent predictors were lower preoperative haemoglobin, reduced BMI, simultaneous bilateral surgery and the extent of surgical treatment. CONCLUSIONS: The developed prognostic model allows prediction for blood transfusion in DDH patients undergoing surgery.