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Minimizing transfusion in sagittal craniosynostosis surgery: the Children's Hospital of Minnesota Protocol
Paul J Escher1, Albert Tu2, Susan Kearney3
1University of Minnesota Medical School, Minneapolis, MN, USA.
Insights
A new protocol using erythropoietin (EPO), iron, and tranexamic acid (TXA) significantly reduced blood transfusions in sagittal craniosynostosis surgery. This approach also shortened hospital stays without adverse effects.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Anesthesiology
Background:
- Sagittal craniosynostosis repair often involves significant blood loss, necessitating transfusions.
- Optimizing perioperative management is crucial for improving patient outcomes and reducing healthcare costs.
Purpose of the Study:
- To evaluate a protocol combining preoperative erythropoietin (EPO) and iron with perioperative tranexamic acid (TXA) for reducing blood transfusions in sagittal craniosynostosis surgery.
Main Methods:
- Retrospective review of 36 patients undergoing open repair for sagittal craniosynostosis.
- Comparison of a historical control group with a study group receiving the EPO, iron, and TXA protocol.
- Analysis of perioperative hemoglobin, transfusion rates, and length of stay.
Main Results:
- The protocol group (14 patients) had a significantly lower transfusion rate (14.3%) compared to the control group (100%, p < 0.0001).
- The study group experienced a shorter postoperative hospital stay (mean 3.4 days vs. 4 days, p = 0.038).
- Preoperative hemoglobin levels were higher in the study group (13.6 g/dL vs. 11.8 g/dL, p = 0.0001).
Conclusions:
- The protocol effectively increased preoperative hemoglobin levels.
- This EPO, iron, and TXA regimen is associated with a low transfusion rate in sagittal craniosynostosis surgery.
- The protocol did not negatively impact the postoperative course and may shorten hospital stays.
Purpose:
To assess the success of a protocol using preoperative erythropoietin (EPO) and iron with perioperative tranexamic acid (TXA) in reducing blood transfusion in sagittal craniosynostosis surgery.
Methods:
A retrospective chart review of all sagittal craniosynostosis patients undergoing open repair at our institution since 2010 was conducted. A novel protocol of preoperative EPO with iron and perioperative TXA, along with a shift away from automatic transfusion, was initiated in 2014. Perioperative hemoglobin levels, length of stay, and transfusion rates were compared between the historical control and the study group receiving the protocol.
Results:
A total of 36 patients met inclusion criteria. Twenty-eight patients were male and 8 were female. Twenty-two patients were in the control group receiving neither TXA nor EPO and automatically received a transfusion, while 14 were in the study group and received the full protocol. There were no significant demographic differences between groups. Within the control group, 100% of patients were transfused compared with 14.3% of the study group (p < 0.0001). The study group also had a shorter postoperative length of stay in the hospital (mean, 3.4 days; range, 3-6) than the control (mean, 4 days; range, 2-5.5, p = 0.038). The study group had a higher preoperative hemoglobin than the control (13.6 vs. 11.8 g/dL, p = 0.0001).
Conclusion:
Our protocol of preoperative EPO and iron with perioperative TXA increased the preoperative hemoglobin and was associated with a low transfusion rate without negatively impacting postoperative course.