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Are routine pre-operative blood tests required in children undergoing primary cleft lip and/or palate repair?
1Spires Cleft Centre, Oxford Radcliffe Hospitals NHS Trust, Headley Way, Oxford OX3 9DU, UK. Karen.a.eley@gmail.com
Insights
Routine pre-operative blood tests for cleft lip and palate repair surgery are often unnecessary. Most children do not require transfusions, and the stress and cost outweigh the minimal benefits of these blood tests.
Area of Science:
- Pediatric Surgery
- Hematology
- Anesthesiology
Background:
- Primary cleft lip and/or palate repair is a common early childhood surgery.
- Pre-operative blood tests in young children can cause significant anxiety.
- Current practices for pre-operative blood work in cleft repair vary.
Purpose of the Study:
- To evaluate the necessity and yield of pre-operative full blood count (FBC) and transfusion requirements in children undergoing primary cleft repair.
- To compare findings with the practices and experiences of cleft surgeons across the UK and Ireland.
Main Methods:
- Retrospective review of electronic data for 282 children undergoing primary cleft repair over five years.
- Analysis of pre-operative full blood count and post-operative transfusion needs.
- a questionnaire survey of primary cleft surgeons in the UK and Ireland regarding their pre-operative blood test protocols and transfusion experiences.
Main Results:
- Only three out of 282 children required post-operative blood transfusion.
- Concurrent illness contributed to transfusion requirements in two cases.
- A 96% response rate from UK and Ireland cleft surgeons indicated that most no longer request routine pre-operative blood tests, citing infrequent transfusion needs and unpredictable requirements.
Conclusions:
- Routine pre-operative full blood count and group and save procedures for primary cleft repair offer minimal benefit.
- The psychological stress on children and families, along with significant cost implications for the Health Service, outweigh the low incidence of transfusion requirements.
- Clinical judgment and selective testing may be more appropriate than routine pre-operative blood work in this pediatric surgical population.
Abstract:
Primary surgical repair of cleft lip and/or palate is performed before 9 months of age, often representing the first surgical intervention these children encounter. Obtaining pre-operative blood tests in young children often produces much anxiety for all involved. We reviewed the electronic data of 282 children over a five-year period undergoing primary cleft repairs to determine the value of pre-operative full blood count, and transfusion requirements. Of these, three children required post-operative blood transfusion. In two cases concurrent illness contributed to transfusion requirement. To determine if our findings were consistent with those at other Cleft Centres, the views of primary cleft surgeons in the UK and Ireland were obtained using a questionnaire. A 96% response rate was achieved. The majority of cleft surgeons stated they no longer request routine pre-operative blood tests. Few could recall any of their patients requiring transfusion, and in those that did there was an underlying medical condition contributing to transfusion requirement, and an equal number whom could not have been predicted pre-operatively. The benefit of obtaining routine full blood count and group and save in children undergoing cleft repair is small in comparison to the stress caused from obtaining these bloods, and has significant cost implications to the Health Service.
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