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Risk Factors Associated With Allogenic Blood Transfusion in Primary Infant Cranial Vault Remodeling
Michael P Subichin1, Ananth S Murthy, Niyant V Patel
1Division of Plastic Surgery, Akron Children's Hospital, Akron, OH.
Insights
Infants undergoing cranial vault remodeling with lower weight, longer surgery, or fronto orbital advancement face higher risks of blood transfusion, even with blood management protocols. Further research may refine these protocols to improve patient outcomes.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Hematology
Background:
- Cranial vault remodeling often leads to significant blood loss and high transfusion rates.
- Blood management protocols aim to reduce blood loss and transfusion needs in these procedures.
- This study investigates transfusion risk factors post-protocol implementation.
Purpose of the Study:
- Identify risk factors for allogeneic blood product transfusion in infants undergoing cranial vault remodeling.
- Evaluate the effectiveness of blood management protocols in reducing transfusion rates.
- Inform strategies to further minimize blood loss and transfusion requirements.
Main Methods:
- Retrospective review of pediatric patients (<18 months) undergoing cranial vault remodeling.
- Analysis of patient data following the implementation of a blood management protocol.
- Comparison of characteristics between patients who received allogeneic blood transfusions and those who did not.
Main Results:
- Eleven of 35 (31%) patients received allogeneic blood transfusions.
- Transfused patients had lower absolute weight (P=0.04) and longer procedure times (P<0.01).
- Fronto orbital advancement was significantly associated with transfusion (91% vs 46%, P=0.02).
Conclusions:
- Lower weight, extended operative duration, and fronto orbital advancement are key predictors of transfusion.
- These factors remain significant even with established blood management protocols.
- Modifying surgical approaches and managing patient weight may further reduce transfusion needs.
Introduction:
Cranial vault remodeling is commonly associated with high blood loss and high transfusion rates. Blood management protocols have recently been developed to minimize blood loss and reduce transfusion requirements. We sought to determine risk factors associated with blood product transfusion for infants undergoing primary cranial vault remodeling after the implementation of a blood management protocol.
Methods:
A retrospective review of patients who underwent cranial vault remodeling at a single center was performed. Patients under 18 months of age who underwent cranial vault remodeling after the establishment of a blood management protocol were included.
Results:
Thirty-five patients were identified. Eleven patients (31%) received allogenic blood transfusions. Patients who received allogenic blood transfusions had a lower absolute weight (8.8 kg versus 9.6kg P = 0.04), longer procedure times (337 minutes versus 275 minutes P < 0.01), and were more likely to have undergone fronto orbital advancement (91% versus 46% P = 0.02). There were no significant differences in age, weight percentile, and patient diagnosis between patients who received allogenic blood transfusions and those that did not (P > 0.05).
Conclusion:
Low weight, longer operative times, and fronto orbital advancement are associated with allogenic blood transfusion despite the use of a blood management protocol. Attempts to modify these factors may further improve outcomes.
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