Effective Pediatric Blood Management in Craniosynostosis Surgery: A Long-Term Update.

Area of Science:

• Pediatric surgery
• Anesthesiology
• Hematology

Background:

• Blood transfusion is frequent in cranial vault reconstruction (CVR) surgeries.
• Minimizing transfusions through protocolized methods is an ongoing area of research.
• This study evaluates long-term outcomes of a pediatric blood management protocol for CVR.

Purpose of the Study:

• To assess the long-term, prospective outcomes of a pediatric blood management protocol.
• To evaluate the effectiveness of the protocol in reducing blood transfusion requirements in CVR patients.

Main Methods:

• A retrospective control cohort and a prospective cohort were analyzed (January 2015-October 2023).
• The protocol involved preoperative hematologic optimization based on hemoglobin levels, intraoperative tranexamic acid (TXA) or aminocaproic acid, cell-saver technology, and postoperative iron or erythropoietin alfa.
• Statistical significance was set at P <0.05.

Main Results:

• The prospective protocol group (174 patients) showed significantly lower mean estimated blood loss, intraoperative packed red blood cell volume, transfusion rates, and total transfusion volume compared to the control group (20 patients).
• Postoperative hemoglobin was significantly higher in the control group, but hemoglobin at discharge did not differ between groups.
• Mean length of hospital stay was similar between the control and treatment groups.

Conclusions:

• Optimizing blood management is crucial for the CVR population.
• The developed protocol is robust, reproducible, and significantly reduces transfusion requirements in pediatric CVR patients.