The 100 Most Cited Articles on Blood Loss and Transfusion in Surgery for Craniosynostosis: A Bibliometric Analysis...

Blood loss during the surgical management of craniosynostosis surgery is common and frequently requires blood transfusion. Interventions such as minimally invasive surgical approaches have been developed to minimise blood loss, given the morbidity of haemorrhage and the adverse effects of transfusion. This study aimed to identify and characterise the most impactful studies relevant to blood loss and transfusion in surgery for craniosynostosis.

Articles were searched and screened using the Web of Science (WoS) core collection database using keywords related to "blood loss," "transfusion," and "craniosynostosis." The most cited 100 relevant articles published in the English language were selected. Extracted data included WoS bibliographic and citation metrics, study characteristics and design, and keywords. Research theme and Level of Evidence (Oxford Centre of Evidence-Based Medicine) were ascertained. In-built tools on Google Sheets were used to perform and present descriptive statistics with bibliometric data and a citation-based review.

The search returned 299 articles. The most cited relevant 100 articles were published between 1993 and 2022. The USA published the most articles (65%), followed by England (7%) and Canada (4%). The Journal of Craniofacial Surgery published the most articles (25%), followed by the Journal of Neurosurgery Paediatrics (17%) and Plastic and Reconstructive Surgery (10%). The most common research area (as categorised by WoS) was surgery (n=76), paediatrics (n=36), and neurosurgery (n=33). The most common research themes were endoscopic or minimally invasive interventions (31%), blood loss and transfusions (27%), and pharmacological interventions (21%). Most articles had a Level of Evidence of III (49%) or IV (22%).

This novel analysis and review highlights the most influential articles in this field, as well as key themes that have shaped current clinical practice. These insights may help clinicians, researchers, and policymakers who continue to evaluate the surgical management of craniosynostosis.