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Transfusion requirements for craniosynostosis surgery in infants
A C Eaton1, J L Marsh, T K Pilgram
1Department of Surgery, Washington University School of Medicine, St. Louis, Mo.
Insights
Craniosynostosis surgery in young children rarely leads to excessive blood loss or transfusion complications. Anesthesiologist and neurosurgeon expertise significantly impacts transfusion needs, more so than the specific suture involved.
Area of Science:
- Pediatric Surgery
- Neurosurgery
- Anesthesiology
Background:
- Craniosynostosis surgery involves significant blood loss and transfusion risks in young children.
- Previous studies have not fully elucidated the variables influencing transfusion requirements.
Purpose of the Study:
- To determine transfusion requirements in pediatric craniosynostosis surgery.
- To document associated morbidity.
- To identify causative variables linked to transfusion.
Main Methods:
- Retrospective review of 73 pediatric craniosynostosis cases (1978-1992).
- Data collected included operative details, hematocrit levels, and transfusion volumes.
- Transfusion volumes analyzed as percent estimated red cell mass.
Main Results:
- Mean intraoperative transfusion was 72.1% estimated red cell mass.
- Transfusion rates varied significantly based on neurosurgeon, anesthesiologist, and affected suture.
- No excessive hemorrhage or transfusion morbidity was observed.
Conclusions:
- Extensive cranio-orbital surgery for craniosynostosis is generally safe regarding blood loss.
- Neurosurgeon and anesthesiologist experience are critical factors influencing transfusion needs.
- Suture involvement is less predictive of transfusion requirements than surgical team expertise.
Abstract:
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.
