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Research Snapshot Theater: Quality and Patient Safety, Pediatric IV

Reducing Red Blood Cell Transfusions in Patients Undergoing Neuromuscular Spinal Fusion Surgeries

Monday, March 23, 2026
11:30 AM - 12:30 PM Central Time
Location: Connections Central - RST 10

  • Venessa L. Pinto, MBBS, FAAP (she/her/hers)

    Baylor College of Medicine Texas Children's Hospital, Texas

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • VB

    Valentina Briceno Marmol, BSN, RN, CNOR

    Assistant Director, Perioperative Quality & Regulatory
    Texas Children's Hospital

    Disclosure information not submitted.

  • MA

    Melissa Ard, MBA, BSN, RN

    Clinical Data Specialist, PeriOperative Services
    Texas Children's Hospital

    Disclosure information not submitted.

  • FR

    Farrah Russell, MD

    Assistant Professor of Anesthesiology
    Texas Children's Hospital

    Disclosure information not submitted.

  • HL

    Hensch Lisa, MD

    Associate Medical Director, Blood Bank and Pheresis
    Texas Children's Hospital

    Disclosure information not submitted.

  • JT

    Jun Teruya, MD, DSc, FCAP

    Chief, Division of Transfusion Medicine & Coagulation
    Texas Children's Hospital

    Disclosure information not submitted.

  • TG

    Tanisha George Daugherty, MMS, PA-C

    Physician Assistant-Certified
    Texas Children's Hospital

    Disclosure information not submitted.

  • WM

    Wallis Molchen, MD

    Assistant Professor of Pediatrics
    Texas Children's Hospital

    Disclosure information not submitted.

  • NM

    Nicole Montgomery, MD

    Associate Professor, Orthopedic Surgery
    Texas Children's Hospital

    Disclosure information not submitted.

  • RC

    Ryan Coleman, MD

    System Medical Director For Procedural Quality
    Texas Children's Hospital

    Disclosure information not submitted.

  • DH

    Darrell Hanson, MD

    Attending Surgeon, Orthopedic Surgery
    Texas Children's Hospital

    Disclosure information not submitted.

  • FG

    Frank Gerow, MD

    Associate Professor, Orthopedic Surgery
    Texas Children's Hospital

    Disclosure information not submitted.

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.