Predictors of perioperative complications in paediatric cranial vault reconstruction surgery: a multicentre observational study from the Pediatric Craniofacial Collaborative Group

Zurakowski, David; Isaac, Kathryn V.; Taicher, Brad M.; Fernandez, Patrick; Derderian, Courtney K.; Hetmaniuk, Mali; Stricker, Paul A.; Abruzzese, Christopher; Apuya, Jesus; Beethe, Amy; Benzon, Hubert A.; Binstock, Wendy; Brzenski, Alyssa; Budac, Stefan; Busso, Veronica; Chhabada, Surendrasingh; Chiao, Franklin; Cladis, Franklyn P.; Claypool, Danielle; Collins, Michael; Dabek, Rachel; Dalesio, Nicholas M.; Falconl, Ricardo; Fernández, Allison M.; Fiadjoe, John E.; Gangadharan, Meera; Gentry, Katherine R.; Glover, Chris D.; Goobie, Susan M.; Gosman, Amanda; Grap, Shannon; Gries, Heike; Griffin, Allison; Haberkern, Charles M.; Hajduk, John; Hall, Rebecca; Hansen, Jennifer; Hsieh, Vincent; Huang, Henry; Ingelmo, Pablo; Ivanova, Iskra; Jain, Ranu; Kars, Michelle; Kowalczyk‐Derderian, Courtney; Kugler, Jane; Labovsky, Kristen; Lakheeram, Indrani; Lee, Andrew; Martínez, José Luis; Masel, Brian; Medellin, Eduardo; Meier, Petra M.; Levy, Heather Mitzel; Muhly, Wallis T.; Muldowney, Bridget L.; Nelson, Jonathon; Nicholson, Julie; Nguyen, Kim‐Phuong; Nguyen, Thanh T.; Olutuye, Olutoyin; Owens‐Stubblefield, Margaret; Parekh, Uma R.; Petersen, Timothy R.; Pohl, Vanessa; Post, Julian; Poteet‐Schwartz, Kim; Prozesky, Jansie; Reddy, Srijaya K.; Reid, Russell R.; Ricketts, Karene; Rubens, Daniel; Ryan, Laura; Skitt, Rochelle; Soneru, Codruta; Spitznagel, Rachel A; Singh, Davinder; Singhal, Neil Raj; Sorial, Emad; Staudt, Susan R.; Stubbeman, Bobbie L.; Sung, Wai; Syed, Tariq; Szmuk, Peter; Thompson, Douglas; Tretault, Lisa; Ungar‐Kastner, Galit; Watts, Rheana; Wieser, John P.; Wong, Karen; Zamora, Lillian

doi:10.1016/j.bja.2018.10.061

Cited by 26 publications

(18 citation statements)

References 25 publications

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“…Bleeding and blood transfusion were commonly seen in children undergoing cardiac, craniosynostosis and scoliosis surgeries (24)(25)(26). The necessary RBC transfusion requirements heightens the risk of transmission of several infectious diseases (27), and seriously burdens hospitals and patients financially.…”

Section: Discussionmentioning

confidence: 99%

Effects of Tranexamic Acid on Bleeding in Pediatric Surgeries: A Systematic Review and Meta-Analysis

Wei

Zhang

Jin³

et al. 2021

Front. Surg.

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Background: Major pediatric surgeries can cause severe intraoperative blood loss. This meta-analysis aims to evaluate the efficacy of tranexamic acid (TXA) in pediatric surgeries.Methods: We searched PubMed, Embase, Web of Science, and Cochrane Library from the conception to March 31, 2021 to identify eligible randomized controlled trials (RCTs) that evaluated the efficacy of TXA in pediatric surgeries. Two reviewers choosed studies, evaluated quality, extracted data, and assessed the risk of bias independently. Mean difference (MD) was calculated as the summary statistic for continuous data. We used a random-effects model to measure mean effects. Data were generated from the corresponding 95% confidence interval (CI) using RevMan 5.3 software. Primary outcomes included intraoperative and postoperative blood loss, red blood cell (RBC) transfusion as well as fresh frozen plasma (FFP) transfusion.Results: Fifteen studies enrolling 1,332 patients were included in this study. The pooled outcomes demonstrated that TXA was associated with a decreased intraoperative (MD = −1.57 mL/kg, 95% CI, −2.54 to −0.60, P = 0.002) and postoperative (MD = −7.85 mL/kg, 95% CI, −10.52 to −5.19, P < 0.001) blood loss, a decreased intraoperative (MD = −7.08 mL/kg, 95% CI, −8.01 to −6.16, P < 0.001) and postoperative (MD = −5.30 mL/kg, 95% CI, −6.89 to −3.70, P < 0.001) RBC transfusion, as well as a decreased intraoperative (MD = −2.74 mL/kg, 95% CI, −4.54 to −0.94, P = 0.003) and postoperative (MD = −6.09 mL/kg, 95% CI, −8.26 to −3.91, P < 0.001) FFP transfusion in pediatric surgeries. However, no significant difference was noted between two groups in duration of surgery (MD = −12.51 min, 95% CI −36.65 to 11.63, P = 0.31). Outcomes of intraoperative and postoperative blood loss and the duration of surgery in included studies were not pooled due to the high heterogeneity.Conclusion: This meta-analysis demonstrated that TXA was beneficial for bleeding in pediatric surgeries.

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Section: Discussionmentioning

confidence: 99%

Effects of Tranexamic Acid on Bleeding in Pediatric Surgeries: A Systematic Review and Meta-Analysis

Wei

Zhang

Jin³

et al. 2021

Front. Surg.

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“…In fact, a recent multicenter study by the pediatric craniofacial collaborative group reported a 15% complication rate. 2 Despite this relatively high complication rate, there was no in-hospital mortality for patients undergoing cranial vault reconstruction surgery. This supports our categorization of craniosynostosis surgery as a procedure with a low intrinsic surgical risk of mortality.…”

Section: Competing Interestsmentioning

confidence: 99%

Improving Pediatric Risk Stratification: Reply

Nasr

Staffa²,

Zurakowski³

et al. 2020

Anesthesiology

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“…More than 90% of craniofacial surgical procedures performed in children worldwide are associated with transfusion of blood products. 1,2 Intraoperative bleeding, measuring half to a whole a blood volume, is attributed to numerous factors, including accelerated fibrinolysis. 3 Anti-fibrinolytic agents are the most common effective pharmaceutical patient blood management (PBM) intervention.…”

Section: Editor's Key Pointsmentioning

confidence: 99%

High-dose versus low-dose tranexamic acid for paediatric craniosynostosis surgery: a double-blind randomised controlled non-inferiority trial

Goobie

Staffa

Meara

et al. 2020

British Journal of Anaesthesia

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Background: Tranexamic acid (TXA) reduces blood loss and transfusion in paediatric craniosynostosis surgery. The hypothesis is that low-dose TXA, determined by pharmacokinetic modelling, is non-inferior to high-dose TXA in decreasing blood loss and transfusion in children. Methods: Children undergoing craniosynostosis surgery were enrolled in a two-centre, prospective, double-blind, randomised, non-inferiority controlled trial to receive high TXA (50 mg kg À1 followed by 5 mg kg À1 h À1 ) or low TXA (10 mg kg À1 followed by 5 mg kg À1 h À1 ). Primary outcome was blood loss. Low dose was determined to be non-inferior to high dose if the 95% confidence interval (CI) for the mean difference in blood loss was above the non-inferiority margin of e20 ml kg À1 . Secondary outcomes were transfusion, TXA plasma concentrations, and biological markers of fibrinolysis and inflammation. Results: Sixty-eight children were included. Values were non-inferior regarding blood loss (39.4 [4.4] vs 40.3 [6.2] ml kg À1 [difference¼0.9; 95% CI: e14.2, 15.9]) and blood transfusion (21.3 [1.6] vs 23.6 [1.5] ml kg À1 [difference¼2.3; 95% CI: e2.1, 6.7]) between high-dose (n¼32) and low-dose (n¼34) groups, respectively. The TXA plasma concentrations during surgery averaged 50.2 (8.0) and 29.6 (7.6) mg ml À1 . There was no difference in fibrinolytic and inflammatory biological marker concentrations. No adverse events were observed. Conclusions: Tranexamic acid 10 mg kg À1 followed by 5 mg kg À1 h À1 is not less effective than a higher dose of 50 mg kg À1 and 5 mg kg À1 h À1 in reducing blood loss and transfusion in paediatric craniosynostosis surgery. Clinical trial registration: NCT02188576.

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Predictors of perioperative complications in paediatric cranial vault reconstruction surgery: a multicentre observational study from the Pediatric Craniofacial Collaborative Group

Cited by 26 publications

References 25 publications

Effects of Tranexamic Acid on Bleeding in Pediatric Surgeries: A Systematic Review and Meta-Analysis

Effects of Tranexamic Acid on Bleeding in Pediatric Surgeries: A Systematic Review and Meta-Analysis

Improving Pediatric Risk Stratification: Reply

High-dose versus low-dose tranexamic acid for paediatric craniosynostosis surgery: a double-blind randomised controlled non-inferiority trial

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