Reducing Blood Loss in Synostosis Surgery

Abstract

Correction of craniosynostosis represents much of the workload in the pediatric designated UK craniofacial units. We reviewed recent operations as part of an ongoing unit audit cycle with outcome determined as blood use and complications or readmissions within 6 weeks of surgery. A pro forma was designed, and information from a chart search was collated on a Microsoft Excel (Microsoft, Seattle, WA) spreadsheet. Thirty-four patients were treated between March 2005 and December 2006, including 13 who underwent scaphocephaly correction (SC) and 21 who underwent fronto-orbital advancement and remodeling (FOAR). In the FOAR group, 13 patients received continuous autologous transfusion, and 8 patients did not. Continuous autologous transfusion system was not used in any of the patients who underwent SC. The results showed that allogeneic transfusion rates were 46 +/- 36% red cell volume (RCV) in FOAR when a cell saver was used and 50 +/- 21% RCV when it was not. There was no significant difference between each group; however, 25% of patients received no transfusion in the cell saver group, whereas all patients undergoing FOAR were transfused in the non-cell saver group. Transfusion in SC was calculated as 26 +/- 25% RCV, and 33% of patients underwent SC without transfusion. In conclusion, we show that significant reductions in blood transfusion are possible in correction of craniosynostosis both with and without the use of cell savers by application of a simple protocol. Our findings support the recommendation that all of these cases be carried out in multidisciplinary units where high patient throughput allows both maintenance of skills and completion of audit cycles.

Haemostatic effect of aprotinin during craniosynostotic surgery in children

“…Known risk factors are infections in the form of viral transmission and immunosuppression as well as transfusion‐related lung injuries. To reduce blood loss and consequent risks, various methods and treatment strategies have been used such as cell salvage, transfusion of autogenic blood, recombinant erythropoietin to increase the red cell mass, and drugs effecting coagulation such as, e.g. tranexamic acid, aprotinin, and activated factor VII.…”

Effect of transfusion guidelines on postoperative transfusion in children undergoing craniofacial reconstruction surgery

“…This study dealt exclusively with PRBC transfusion and did not address transfusion of other blood components. Although perioperative FFP transfusion is infrequent at some institutions (11,15,18,22), FFP transfusion remains relatively common at others, with centers reporting rates of 22% (7) and 53% (23). Our data highlight the value of establishing specific postoperative transfusion thresholds for all blood components rather than only PRBCs.…”

Use of blood-sparing surgical techniques and transfusion algorithms: association with decreased blood administration in children undergoing primary open craniosynostosis repair

“…19,39 Although there appears to be low use of intraoperative transfusion algorithms in CFR patients, recent publications have associated the use of protocols with decreased transfusion. 6,32,35 Furthermore, experts in the field recommend transfusion protocols as a first-line approach to safely minimize transfusion in these patients. 33 Surgical technique changes were not novel but only focused on reducing unnecessary blood loss during skin opening and craniotomy, similar to those used on all infants undergoing craniotomy or neurosurgical intervention at our institution since late 2012.…”