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Intraoperative optimization to decrease postoperative PRBC transfusion in children undergoing craniofacial
Thanh T Nguyen1, Humphrey V Lam, Maxie Phillips
1Division of Pediatric Anesthesiology, Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN, USA.
Insights
Maintaining a postoperative hematocrit (Hct) above 30% in pediatric patients undergoing craniofacial reconstruction can significantly reduce the need for subsequent red blood cell (RBC) transfusions. This finding offers a strategy to minimize donor blood exposure in high-risk surgical cases.
Area of Science:
- Pediatric Surgery
- Hematology
- Anesthesiology
Background:
- Craniofacial reconstructive surgery for craniosynostosis often leads to significant blood loss and requires intraoperative transfusions.
- Postoperative blood loss can necessitate further transfusions, increasing patient risk.
Purpose of the Study:
- To identify modifiable intraoperative factors associated with postoperative blood transfusions in pediatric craniofacial reconstruction.
- To investigate the relationship between initial postoperative hematocrit and the need for transfusion.
Main Methods:
- Retrospective analysis of 55 pediatric patients undergoing primary craniofacial reconstruction.
- Evaluation of 20 demographic and perioperative variables using logistic regression and Bayesian model averaging.
- Calculation of an initial postoperative hematocrit threshold for transfusion risk.
Main Results:
- Initial postoperative hematocrit (Hct) was the sole significant predictor of postoperative PRBC transfusion (OR 0.69, P=0.0016).
- An initial postoperative Hct threshold of 30% was calculated.
- Patients with an initial postoperative Hct above 30% experienced a 50% reduction in the absolute risk of receiving a PRBC transfusion.
Conclusions:
- Maintaining an initial postoperative Hct above 30% may decrease the likelihood of requiring postoperative transfusions.
- Transfusing residual intraoperative packed red blood cells (PRBCs) to achieve a Hct >30% could be a justifiable strategy.
- This approach aims to reduce the need for transfusions from different donors in the postoperative period.
Background:
Craniofacial reconstructive surgery for craniosynostosis is associated with large blood loss and intraoperative transfusion. This blood loss may continue through the initial postoperative period, potentially resulting in transfusion postoperatively. The purpose of this study is to determine if there is an association between any modifiable intraoperative factors and postoperative blood transfusion in this patient population.
Methods:
A cohort of 55 pediatric patients who underwent primary craniofacial reconstruction at Vanderbilt Children's Hospital from January 1, 2013 to April 31, 2014 was analyzed. The authors analyzed 20 different demographic and perioperative variables for statistical associations with postoperative PRBC transfusion using multiple logistic regression with optimal models being selected by Bayesian model averaging.
Results:
The optimal regression model only included initial PACU Hct as a predictor and showed a significant association between this variable and postoperative PRBC transfusion (odds ratio 0.69, 95% CI 0.55-0.87, P = 0.0016). Based on the average decrease in postoperative hematocrit (Hct) and the postoperative transfusion trigger, an initial PACU Hct threshold of 30 was calculated. In our patient sample, an initial PACU Hct above 30 was associated with a 50% decrease in the absolute risk of receiving a PRBC transfusion postoperatively.
Conclusions:
Based on this retrospective analysis, it may be justifiable to transfuse residual volume from previously exposed intraoperative PRBCs to a Hct above 30 to decrease the likelihood of subsequent blood transfusions from different donors in the postoperative period.
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