Perioperative Management to Minimize Blood Transfusion in Craniosynostosis Surgery

Area of Science:

• Pediatric Surgery
• Hematology
• Anesthesiology

Background:

• Craniosynostosis surgery is highly invasive, leading to substantial blood loss and high transfusion rates (87-95%) in children.
• Effective perioperative management is crucial to mitigate complications associated with transfusions.

Purpose of the Study:

• To identify factors associated with reduced perioperative transfusion requirements in pediatric craniosynostosis surgery.
• To optimize blood conservation strategies for improved patient outcomes.

Main Methods:

• Retrospective analysis of 69 craniosynostosis surgeries (2013-2023) with a transfusion threshold of Hb <7 g/dL.
• Evaluation of surgical techniques (endoscopic suturectomy, calvarial vault remodeling, distraction osteogenesis) and blood conservation strategies (hemodilution, Cell Saver®, iron supplements, tranexamic acid).
• Receiver operating characteristic curve analysis to determine key transfusion-reducing factors.

Main Results:

• The overall transfusion rate was reduced to 34.8%.
• Factors significantly associated with lower transfusion needs included minimized blood loss, older patient age, and preoperative iron supplementation.
• Subgroup analysis showed autologous blood recovery effectiveness in patients ≥10 kg, while preoperative iron supplementation was key for those <10 kg.

Conclusions:

• Minimizing intraoperative blood loss is critical for reducing transfusion requirements.
• Optimizing preoperative hemoglobin levels through iron supplementation is essential, particularly for younger/smaller patients.
• Combining strategies like autologous blood recovery and optimizing hemoglobin levels significantly lowers transfusion rates, improving safety and outcomes in pediatric craniosynostosis surgery.