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Effect of transfusion guidelines on postoperative transfusion in children undergoing craniofacial reconstruction
Paul A Stricker1, John E Fiadjoe, Todd J Kilbaugh
1Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. strickerp@email.chop.edu
Insights
Implementing new management guidelines significantly reduced postoperative transfusions in pediatric cranial vault reconstruction patients. This strategy, using specific transfusion thresholds, proved effective and cost-efficient for reducing blood product use.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Transfusion Medicine
Background:
- Cranial vault reconstruction surgery in children can lead to significant postoperative blood loss and transfusion requirements.
- Standardized postoperative management guidelines are crucial for optimizing patient outcomes and resource utilization in pediatric surgical procedures.
Purpose of the Study:
- To evaluate the impact of implementing population-specific postoperative management guidelines on the rate of postoperative transfusions in pediatric patients undergoing cranial vault reconstruction.
Main Methods:
- A retrospective observational study with historical controls was conducted at a single, large, academic tertiary pediatric hospital.
- Data were collected from a craniofacial surgery perioperative registry for children aged 6 months to 17 years undergoing fronto-orbital advancement or posterior cranial vault reconstruction.
- Postoperative management guidelines, including projected surgical drain output and specific transfusion thresholds, were implemented on December 1, 2009.
Main Results:
- The study compared 59 procedures in the preguideline cohort with 58 procedures in the postguideline cohort.
- No statistically significant differences were observed in immediate postoperative hematocrit or postoperative drain blood loss between the groups.
- The prevalence of postoperative transfusion of any blood product significantly decreased in the postguideline cohort (17% vs. 42%, p = .003), primarily due to a reduction in fresh frozen plasma transfusion (5% vs. 25%, p = .002).
Conclusions:
- Implementation of postoperative management guidelines was associated with a 60% reduction in postoperative transfusions in pediatric patients undergoing cranial vault reconstruction.
- The use of transfusion thresholds represents a simple, cost-effective, and efficient strategy for reducing perioperative transfusions in this patient population.
- These guidelines should be considered a first-line approach for perioperative transfusion reduction in pediatric craniofacial surgery.
Objective:
To assess the effect of implementation of population-specific postoperative management guidelines on postoperative transfusion in children undergoing cranial vault reconstruction surgery.
Design:
Retrospective observational study with historical controls.
Setting:
Single, large, academic tertiary pediatric hospital.
Patients:
: Children aged 6 months to 17 yrs undergoing fronto-orbital advancement or posterior cranial vault reconstruction surgery enrolled in our craniofacial surgery perioperative registry from April 14, 2008 to September 7, 2011.
Intervention:
Postoperative management guidelines for children undergoing cranial vault reconstruction surgery were implemented on December 1, 2009. These management guidelines included projected surgical drain output as well as specific transfusion thresholds for packed red blood cells and hemostatic blood products.
Measurements And Main Results:
We queried our craniofacial surgery perioperative registry for children who underwent cranial vault reconstruction to assess transfusion practices before and after the implementation of the postoperative guidelines. Subjects were divided into a preguideline cohort and a postguideline cohort. Perioperative demographic data and postoperative transfusion data were compared between the two groups. The registry query returned data on 59 procedures in the preguideline cohort and 58 procedures in the postguideline cohort. The immediate postoperative hematocrit and the postoperative blood loss through surgical drains were not statistically different in the two groups. The prevalence of postoperative transfusion of any blood product was significantly less in the postguideline cohort (17% vs. 42%, p = .003). Most of the transfusion reduction was achieved through a reduction in fresh frozen plasma transfusion (5% vs. 25%, p = .002).
Conclusions:
In this observational study, the implementation of postoperative management guidelines was associated with a 60% reduction in postoperative transfusion. The use of transfusion thresholds is a simple, inexpensive, and effective strategy for transfusion reduction and should be a first-line approach to perioperative transfusion reduction in this population.
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