Risk Factors for Intraoperative Blood Transfusion in Pediatric Percutaneous Nephrolithotomy

Objective: This study aimed to identify risk factors for intraoperative blood transfusion during pediatric percutaneous nephrolithotomy (PCNL) to stratify high-risk patients and optimize perioperative blood management. Methods: We retrospectively analyzed clinical data from 472 pediatric patients who underwent PCNL at the People’s Hospital of Xinjiang Uygur Autonomous Region, between January 2013 and September 2024. Patients were divided into transfusion and non-transfusion groups based on need for intraoperative transfusion. A total of 34 variables were collected, including demographics, preoperative laboratory parameters, stone characteristics, and surgical details. Candidate risk factors were initially selected using least absolute shrinkage and selection operator regression, followed by multivariable logistic regression to identify independent risk factors. Predictive performance was evaluated by receiver operating characteristic (ROC) curve analysis. Results: The transfusion rate was 5.9% (28/472). Multivariable analysis revealed three independent risk factors: larger tract size (mini vs ultra-mini: odds ratio [OR] 3.08, 95% confidence interval [CI] 1.10–10.97; standard vs ultra-mini: OR 24.31, 95% CI 5.95–110.55; p < 0.05), multi-tract access (OR 4.56, 95% CI 1.37–13.23; p = 0.0076), and preoperative urine WBC positivity (OR 3.70, 95% CI 1.22–16.10; p = 0.0397). The combination of these three factors demonstrated superior predictive performance (area under the curve [AUC] = 0.796) compared to individual factors (AUC range: 0.562–0.703). Conclusion: This study identified larger tract size, multi-tract access, and preoperative urine WBC positivity as independent risk factors for intraoperative blood transfusion in pediatric PCNL. These findings enhance clinical decision-making by enabling targeted perioperative blood management strategies in high-risk pediatric patients.