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Blood replacement practices for complex orthognathic surgery: a single surgeon's experience.
Jeffrey C Posnick1, Alexander Rabinovich, Daniel T Richardson
1Posnick Center for Facial Plastic Surgery, Chevy Chase, MD 20815, USA. jposnick@drposnick.com
Summary
Blood transfusions are rarely needed for orthognathic surgery patients. This study found only 6% of patients required blood replacement, highlighting the effectiveness of current surgical and anesthesia protocols.
Area of Science:
- Oral and Maxillofacial Surgery
- Anesthesiology
- Transfusion Medicine
Background:
- Orthognathic surgery, including procedures like Le Fort I osteotomy and bilateral sagittal split osteotomies, can be associated with significant blood loss.
- Preoperative autologous blood donation is a common practice, but its necessity in modern orthognathic surgery requires evaluation.
Purpose of the Study:
- To assess blood replacement practices in patients undergoing major orthognathic and intranasal surgery.
- To determine the actual transfusion rates in a series of complex surgical cases.
Main Methods:
- Retrospective review of 34 consecutive patients undergoing simultaneous Le Fort I osteotomy, bilateral sagittal split osteotomies, septoplasty, and inferior turbinate reduction.
- Analysis of patient records, including office charts, hospital records, and blood bank data.
Main Results:
- 76% of patients opted for autologous blood donation.
- Only 6% of patients (2 out of 34) ultimately required a blood transfusion.
- Of the transfused patients, one received autologous blood and the other received homologous blood.
- 97% of donated autologous blood units were ultimately discarded.
Conclusions:
- Blood transfusions are infrequently required in patients undergoing complex orthognathic and intranasal surgery.
- Close collaboration between surgical and anesthesia teams, along with safe patient monitoring, likely contributes to reduced transfusion needs.
- The study suggests a low incidence of transfusion necessity, questioning the routine use of preoperative autologous blood donation in this patient population.