Factors predicting blood transfusion in endoscopic metopic strip craniectomy-analysis of 102 consecutive cases

Endoscopic strip craniectomy (ESC) provides a safe surgical approach for the management of metopic craniosynostosis. However, it has a higher reported blood transfusion requirement than ESC for other sutures. We sought identify factors that may be related to greater blood transfusion use.

Retrospective consecutive case series. All metopic ESC cases were identified from the institutional database. Case notes reviewed following pre-drafted proforma, with regression analysis to identify risk factors for transfusion.

One hundred two consecutive cases of ESC for metopic synostosis were identified. At the time of ESC, the mean age was 4.4 months (range: 2-10 months) and the mean weight was 7.0 kg (range 4.8-10.3 kg) at the time of surgical intervention. Our mean operative time was 75 min (range 33-142 min). Twenty-seven (26.5%) children received blood transfusions in the cohort. Multivariate analysis revealed that longer operative times (P < 0.05) and lower pre-operative hemoglobin levels (P < 0.05) were associated with a greater need for blood transfusion. Other factors, including patient age, weight and place in series did not correlate with need for transfusion. There was no significant morbidity, and no mortality, in this cohort.

Despite increasing experience in a high-volume unit, a significant proportion of infants undergoing ESC for metopic synostosis will require blood transfusion. Identifiable risk factors were low pre-operative hemoglobin and longer operative time, suggesting focusing on pre-operative optimization and efficient operating may reduce transfusions in the future. Despite this transfusion rate, our data suggests ESC for metopic synostosis remains a safe procedure in experienced hands.