Perioperative Management and Factors Associated With Transfusion in Cranial Vault Reconstruction

Area of Science:

• Neurosurgery
• Pediatric Surgery
• Anesthesiology

Background:

• Bleeding is a common complication in cranial vault reconstruction.
• This study compares transfusion rates in patients undergoing cranial vault reconstruction at Children's Hospital and Medical Center (CHMC) to a national dataset.

Purpose of the Study:

• To evaluate whether patients at CHMC have lower blood transfusion rates compared to a national sample.
• To identify factors associated with perioperative transfusion in pediatric cranial vault reconstruction.

Main Methods:

• Retrospective query of the Pediatric National Surgical Quality Improvement Program (Peds-NSQIP) database.
• Comparison of patients undergoing cranial vault reconstruction (CPT 61559) at CHMC with a national cohort from Peds-NSQIP.
• Exclusion of patients over 24 months; binary logistic regression analysis performed for transfusion-associated factors at CHMC.

Main Results:

• CHMC cohort (N=54) showed significantly shorter preincision anesthesia and operative times compared to Peds-NSQIP (N=1320).
• Transfusion rates were lower (50% vs. 73%) and mean transfusion volumes smaller (16 vs. 33 mL/kg) at CHMC.
• Factors associated with lower transfusion at CHMC included higher preoperative hematocrit, antifibrinolytic agent use, and specific incision temperatures.

Conclusions:

• Patients at CHMC undergoing cranial vault reconstruction demonstrate reduced need for blood transfusions.
• Preoperative hematocrit, antifibrinolytic administration, and intraoperative temperature are key modifiable factors impacting perioperative transfusion requirements.