Transfusion requirements for craniosynostosis surgery in infants

Retrospective review of the records of 73 consecutive young children who underwent craniosynostosis surgery between 1978 and 1992 in one center was conducted to determine transfusion requirements, to document morbidity, and to identify causative variables associated with transfusion. Operative age and weight, affected suture(s), craniofacial surgeon, neurosurgeon, anesthesiologist, preoperative and postoperative hematocrit, and transfusion volumes of blood and crystalline products were recoded. Transfusion volumes were converted to percent estimated red cell mass for analysis. Affected sutures were unicoronal (22), sagittal (17), bicoronal (11), multiple (11), metopic (10), and lambdoid (2). Mean operative age was 6.4 months. Mean preoperative hematocrit was 34 percent. Eighty percent of patients were discharged with hematocrit of 29 percent or greater. Discharge hematocrit was unrelated to year of surgery. Mean intraoperative transfusion was 72.1 +/- 56.6 percent estimated red cell mass. Transfusions differed statistically among suture(s), neurosurgeons, and anesthesiologists. Extensive cranio-orbital surgery for synostosis in young children does not produce excessive hemorrhage or transfusion morbidity. The anesthesiologist and neurosurgeon may be equally or more important than the affected suture(s) as causal variables in transfusion.