{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T11:38:21Z","timestamp":1785584301114,"version":"3.56.0"},"reference-count":21,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2017,3,21]],"date-time":"2017-03-21T00:00:00Z","timestamp":1490054400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2017,7]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Sacrococcygeal teratomas are a common congenital tumor. Surgical resection can occur <jats:italic>in utero<\/jats:italic>, in the neonatal period, or in the postneonatal period.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>We describe patient and tumor factors associated with mortality and transfusion in this population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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\u2010square test and Fisher's exact test. Variables significant at univariate level were used in multivariate logistic regression and negative binomial regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 112 cases, 6 were <jats:italic>in utero<\/jats:italic> repairs, 73 were neonatal repairs, and 33 were repairs at &gt;30 days of life. There was 17%, 1%, and 0% intraoperative mortality and 33%, 5%, and 0% 30\u2010day mortality in the <jats:italic>in utero<\/jats:italic>, neonatal, and &gt;30 days of life repairs, respectively. All six patients who died within the first 30 days of life had a postmenstrual age of &lt;32 weeks at time of surgery. All six patients who died had noncystic tumors. Patients with noncystic tumors were more likely to be born prior to 30\u2010week gestation (23\/65 vs 6\/47; \u03c7<jats:sup>2<\/jats:sup> = 7.3; <jats:italic>P<\/jats:italic> = 0.007). Gestational age &gt;30 weeks was associated with decreased intraoperative death (0% vs 10%; modified maximum likelihood estimate of <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 0.05; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.002\u20130.96; <jats:italic>P<\/jats:italic> = 0.02). Gestational age &gt;30 weeks (2.4% vs 13.8%; <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 0.15; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.03\u20130.89; <jats:italic>P<\/jats:italic> = 0.04) and cystic morphology (0% vs 9.2%; modified maximum likelihood estimate of <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 0.1; <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.01\u20131.75; <jats:italic>P<\/jats:italic> = 0.04) were associated with decreased 30\u2010day mortality and emergent surgery (17.9% vs 1.2%; <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 18; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 2\u2013162.2; <jats:italic>P<\/jats:italic> = 0.004) was associated with increased 30\u2010day mortality. Gestational age &gt;30 weeks (33.7% vs 62.1%; <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 0.27; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.09\u20130.79; <jats:italic>P<\/jats:italic> = 0.02) and Altman class 3\u20134 (12.1% vs 52.7%; <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 0.1; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.03\u20130.34; <jats:italic>P<\/jats:italic> = 0.0002) were associated with decreased need for transfusion and noncystic tumor was associated with increased transfusion volume (131.6 <jats:styled-content style=\"fixed-case\">ml<\/jats:styled-content>\u00b7kg<jats:sup>\u22121<\/jats:sup> [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 94\u2013184] vs 63 <jats:styled-content style=\"fixed-case\">ml<\/jats:styled-content>\u00b7kg<jats:sup>\u22121<\/jats:sup> [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 40\u2013100.1]; <jats:italic>P<\/jats:italic> = 0.01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Prematurity is associated with increased intraoperative and 30\u2010day 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\u00b7kg<jats:sup>\u22121<\/jats:sup> or greater. In these patients at high risk of mortality due to blood loss, the anesthesia team should be prepared to manage massive transfusion and coagulopathy with blood components and pharmacologic measures.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.13143","type":"journal-article","created":{"date-parts":[[2017,3,21]],"date-time":"2017-03-21T09:00:30Z","timestamp":1490086830000},"page":"726-732","source":"Crossref","is-referenced-by-count":25,"title":["Risk factors for perioperative mortality and transfusion in sacrococcygeal teratoma resections"],"prefix":"10.1111","volume":"27","author":[{"given":"Rebecca S.","family":"Isserman","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine The Children's Hospital of Philadelphia Philadelphia PA USA"},{"name":"Perelman School of Medicine at the University of Pennsylvania Philadelphia PA 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