Predictors of intra-operative blood loss and blood transfusion in orthognathic surgery: a retrospective cohort study in 92 patients

Al-Sebaei, Maisa O

doi:10.1186/preaccept-4938875171344463

Cited by 2 publications

(4 citation statements)

References 13 publications

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“…In this study, as the operation time increased, both the EIBL and RBL also increased. This is similar to the observations of several studies that reported that a longer operative time was associated with greater blood loss during orthognathic surgery 10–12,14–16 . As there was no interoperator variance in this study, the length of operative time is thought to be dependent on the complexity of the surgical plan.…”

Section: Discussionsupporting

confidence: 90%

“…Rummasak et al recommended that patients with lower body weight be prepared for transfusion due to the higher risk of blood loss 12,14 . However, other studies found no significant correlation between BMI and blood loss 11,17 . Considering that RBL reflects the patient's actual risk of blood loss, BMI is a significant predictor of bleeding risk during orthognathic surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies on blood loss during orthognathic surgery mostly investigated only the absolute values of the blood loss measured without considering the patients’ laboratory parameters like hemoglobin (Hb) and hematocrit (Hct). 2,3,10–12 Analyzing only the amount of blood lost cannot reveal the potential risks in individual patients because the same amount of blood loss could induce different hemodynamic effects in different patients. In this study, patient-specific relative blood loss (RBL) was calculated from each patient's blood volume and clinico-laboratory results, this may help evaluate the actual risks of blood loss during orthognathic surgery.…”

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confidence: 99%

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Predictors of Blood Loss During Orthognathic Surgery and the Need for Pre-Deposit Autologous Blood Donation

Kim

Park

et al. 2021

Journal of Craniofacial Surgery

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The aim of this study was to identify the clinicolaboratory predictors of relative blood loss (RBL) during orthognathic surgery and determine the need for predeposit autologous blood donation (PABD) for the surgery. Using a retrospective study design, 297 patients who underwent bimaxillary orthognathic surgery between 2016 and 2020 were enrolled. To investigate patientspecific risk factors, we calculated the allowable blood loss (ABL) for each patient and RBL as the ratio of estimated intraoperative blood loss (EiBL) to ABL. The correlations between the clinicolaboratory variables and EiBL and RBL were analyzed using stepwise multivariate regression analysis, and independent t test and one-way ANOVA were performed.There was no significant difference in transfusion rate between the PABD group (N ¼ 202/279) and non-PABD group (N ¼ 77/279) (P ¼ 0.052). Sex (P < 0.001), body mass index class (P ¼ 0.001), operative time (P < 0.001), and baseline hematocrit (P < 0.001) were significant predictors of EIBL and RBL. EIBL exceeded ABL in only 2 patients. The significant factors of RBL in orthognathic surgery were hematocrit, body mass index, and operative time. Clinicians should be more careful about bleeding in patients with low baseline hematocrit level or high body mass index, or those expected to undergo prolonged surgeries owing to a complicated surgical plan. The need for PABD before orthognathic surgery is low.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Predictors of Blood Loss During Orthognathic Surgery and the Need for Pre-Deposit Autologous Blood Donation

Kim

Park

et al. 2021

Journal of Craniofacial Surgery

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“…Stehrer et al found that the amount of perioperative blood loss was 421.5 ml and bimaxillary group had more blood loss of 494.1 ml. 36 Similar to previous studies, 37,38 we found that intraoperative blood loss was an independent risk factor for autoblood reinfusion. However, the blood loss is difficult to predict before surgery.…”

Section: Discussionsupporting

confidence: 88%

Development and Validation of a Nomogram to Predict the Risk of Blood Transfusion in Orthognathic Patients

Jiang

et al. 2022

Journal of Craniofacial Surgery

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Objective: This study aims to establish a nomogram to predict the probability of blood transfusion in patients with preoperative autologous blood donation before orthognathic surgery. Methods: The authors conducted a retrospective case-control study on consecutive orthognathic patients with preoperative autologous blood donation from January 2014 to December 2020. The outcome variable was the actual transfusion of autologous blood (ATAB). Predictors included patients’ demographics, preoperative blood cell test, vital signs, American Society of Anesthesiologists classification, surgical procedure, operation duration, and blood loss. Univariable and multivariable logistic regressions were performed to identify independent risk factors associated with ATAB. A nomogram was constructed to predict the risk for ATAB. The performance of the nomogram was evaluated using the area under the receiver operating characteristic curve, calibration curve and the consistency index. Results: A total of 142 patients (75 males and 67 females) with an average age of 22.72 ± 5.34 years donated autologous blood before their orthognathic surgery. Patients in the transfusion group (n = 56) had significantly lower preoperative red blood cell counts (4.74 ± 0.55 × 109/L versus 4.98 ± 0.45 × 109/L, P = 0.0063), hemoglobin (141.48 ± 15.18g/dL versus 150.33 ± 14.73g/dL, P = 0.0008), and hematocrit (41.05% ± 4.03% versus 43.32% ± 3.42%, P= 0.0006), more bimaxillary osteotomies (92.86% versus 56.98%, P < 0.001), longer operation duration (348.4 ± 111.10 minutesversus261.6 ± 115.44 minutes, P < 0.001), and more intraoperative blood loss (629.23±273.06 ml versus 359.53 ± 222.84 ml, P < 0.001) than their counterparts (n = 86) in the non– transfusion group. Univariable and multivariable logistic regression demonstrated that only hemoglobin (adjusted odds ratio [OR] 0.864, 95% confidence interval [CI]:0.76–0.98, P= 0.026), operation procedures (adjusted OR 8.14, 95% CI:1.69–39.16, P = 0.009), and blood loss (adjusted OR 1.006, 95% CI:1.002–1.009, P < 0.001) were independent risk factors for ATAB. The area under the receiver operating characteristic curve of the nomogram was 0.823. The consistency index of the nomogram was 0.823. The calibration curve illustrated that the nomogram was highly consistent with the actual observation. Conclusions: The nomogram is a simple and useful tool with good accuracy and performance in predicting the risk for blood transfusion.

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Predictors of intra-operative blood loss and blood transfusion in orthognathic surgery: a retrospective cohort study in 92 patients

Cited by 2 publications

References 13 publications

Predictors of Blood Loss During Orthognathic Surgery and the Need for Pre-Deposit Autologous Blood Donation

Predictors of Blood Loss During Orthognathic Surgery and the Need for Pre-Deposit Autologous Blood Donation

Development and Validation of a Nomogram to Predict the Risk of Blood Transfusion in Orthognathic Patients

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