Reducing blood loss in synostosis surgery: the Liverpool experience

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.