Perioperative Management to Minimize Blood Transfusion in Craniosynostosis Surgery

Craniosynostosis surgery is highly invasive, often resulting in significant blood loss and high transfusion rates (87%-95%) in pediatric patients. This retrospective study aimed to identify factors associated with lower transfusion requirements to improve perioperative management and reduce complications.

We analyzed 69 craniosynostosis surgeries performed from 2013 to 2023. A transfusion threshold of Hb < 7 g/dL was used. Surgical methods basically varied by age: endoscopic suturectomy for infants under 7 months and calvarial vault remodeling or distraction osteogenesis for older children. Blood conservation strategies included acute normovolemic hemodilution, intraoperative autologous blood recovery (Cell Saver), oral iron supplements, and tranexamic acid. Receiver operating characteristic curve analysis was used to determine key transfusion-reducing factors.

The transfusion rate was 34.8%. Significant factors associated with reduced transfusion included blood loss, patient age, and preoperative iron supplementation. In subgroup analysis, for patients weighing ≥10 kg, autologous blood recovery was effective, while for those <10 kg, preoperative iron supplementation improved hemoglobin levels, reducing transfusion requirements. For patients weighing ≥10 kg, blood loss ≤8.8 mL/kg were identified as critical thresholds. Blood loss ≤8.3 mL/kg and preoperative Hb ≥ 9.2 g/dL were optimal for avoiding transfusion in patients weighing <10 kg.

Minimizing blood loss, optimizing preoperative hemoglobin levels, and using autologous blood recovery can significantly reduce transfusion rates. Implementing multiple strategies lowered the overall transfusion rate to 34.8%, potentially reducing complications and improving patient outcomes in pediatric craniosynostosis surgery.