Assessment of perioperative bleeding in pediatric osteogenesis imperfecta patients undergoing orthopedic surgeries: A single-center study

<ns7:p> Background “Osteogenesis imperfecta (OI)” is a heterogeneous group of inherited disorders involving collagen type I with a 10–30% incidence of bleeding diathesis placing these individuals at an increased risk of bleeding. Our study aims to ascertain the risk factors that increase the propensity of perioperative blood transfusions in pediatric population. Methods A single center retrospective observational study of patients aged <18 years undergoing orthopedic surgeries at our tertiary care hospital from January 2016 to August 2024 were included and each surgery was analyzed as a discrete event. Age, type of OI, number of osteotomies, and number of bones operated simultaneously were recorded. The fall in hemoglobin, requirement for blood transfusions and associated factors were analyzed. Estimated blood loss, surgical duration, and surgical approach were not consistently available and were therefore not analyzed. Results Amongst 53 individuals who underwent surgery, 141 procedures were analyzed. A statistically significant postoperative hemoglobin decline was observed overall (mean 12.22 ± 1.06 g/dL preoperatively vs. 10.57 ± 1.48 g/dL postoperatively; p < 0.001). Procedures involving multiple osteotomies were associated with greater hemoglobin decline (p = 0.002) and higher transfusion frequency (16.3% overall; p = 0.001). Type III OI was associated with greater hemoglobin decline compared to other phenotypes (p = 0.01). Younger age showed a statistically significant but weak inverse correlation with hemoglobin decline (R <ns7:sup>2</ns7:sup> = 0.076). Conclusion Our study inferred that the fall in hemoglobin was significant postoperatively in OI patients and was associated with younger age, type III OI, and multiple osteotomies. Before performing orthopedic surgeries on patients with OI, surgeons might consider the latter risk factors to explore therapeutic options aimed at reducing hemorrhage and improving outcomes. </ns7:p>