Risk Factors for Transfusion and Infection Following Pediatric Scoliosis Surgery: Insights from a Latin American Retrospective Cohort

Purpose To identify risk factors for perioperative blood transfusion and postoperative infection following scoliosis correction surgery in a Latin American pediatric population and quantify the cumulative risk for each outcome based on the number of coexisting factors. Methods A retrospective analytical cohort study was conducted on patients under 18 years who underwent posterior scoliosis correction surgery at a single referral centre (2014–2022). Exclusion criteria included spinal trauma, oncologic diagnoses, or multiple surgeries. Primary outcomes were perioperative blood transfusion and postoperative infection within one year. Odds ratios were calculated, and multivariate logistic regression identified independent risk factors. Results Among 427 patients, 34% required transfusion and 8.2% developed infection. Independent risk factors of transfusion included scoliosis type (neuromuscular or syndromic), Cobb angle (70°–90°), ASA score (3–4), and intraoperative blood loss ≥ 40% of blood volume. Infection was independently associated with ASA 3–4 and Cobb angles ≥ 90°. Transfusion accumulated risk ranged from 9.6% (no factors) to 100% (four factors), while infection risk rose from 4.9–72.7% (two factors). Conclusions Preoperative Cobb angle ≥ 90° and ASA 3–4 were independent risk factors of both transfusion and infection. Neuromuscular or Syndromic types of scoliosis and significant intraoperative bleeding were associated with transfusion risk. The higher the number of factors, the higher the cumulative risk of transfusion or infection. These findings offer valuable insights for preoperative risk stratification, enabling more effective planning in complex scoliosis cases.