Blood Transfusion and Cell Saver Utilization in Craniosynostosis Surgery: A Retrospective Analysis

Craniosynostosis surgery is associated with substantial blood loss, yet the utilization of intraoperative cell saver remains variable. To evaluate patterns of cell saver utilization, the authors queried the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) from 2021 through 2024. Patients undergoing craniectomy for craniosynostosis were identified and stratified into single-suture craniectomy and multisuture craniectomy cohorts, and univariable and multivariable analyses were conducted to determine factors associated with transfusion volume and cell saver utilization. Among 4970 identified patients (32.4% female), 2314 were in the single-suture cohort, and 2656 were in the multisuture cohort. Blood transfusion was required in 29.3% of the single-suture cohort and 62.3% of the multisuture cohort, with average transfusion volumes of 18.5±10.3 and 23.0±16.3 mL/kg, respectively. Cell saver was used in 4.3% of transfused patients in the single-suture cohort and 8.6% of transfused patients in the multisuture cohort. Among cell saver users, average transfusion volume was 19.3±10.7 mL/kg in the single-suture cohort and 19.6±16.3 mL/kg in the multisuture cohort. Overall, 96.6% and 74.1% of cell saver users, respectively, avoided allogeneic blood entirely. Operation duration was the factor most strongly and consistently associated with blood transfusion volume and cell saver utilization in both cohorts (P<0.001). In conclusion, the cell saver is infrequently utilized in craniosynostosis surgery, although patients who received autologous blood from a cell saver required less allogeneic blood.