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Blood Loss, Conservation, and Transfusion Patterns in Cranial Vault Remodeling for Craniosynostosis: a National Survey
Hongyang Pi, BS
David E. Kurlander, MD
Krystal Tomei, MD, MPH
Paul A. Tripi, MD
Hollie M. Reeves, DO
Katharine A. Downes, MD
Sanjay Ahuja, MD
Alexandre T. Rotta, MD
Devra Becker, MD
Gregory E. Lakin, MD
University Hospitals Case Medical Center
2016-01-26
Presenter: Hongyang Pi, BS
Affidavit:
this project represents original work of the student. the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting.
Director Name: Hooman Soltanian
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background: Patients undergoing cranial vault remodeling for craniosynostosis frequently experience high blood loss and require blood transfusion. No best-practice guidelines exist for perioperative practices to minimize blood loss and transfusion requirement.
Method: A survey was emailed to 128 members of American Society of Craniofacial Surgeons. Demographics, peri-operative practices, and transfusion outcomes were queried. Whether or not surgeons use a standardized protocol was assessed. Surgeons were asked to complete the survey with input from anesthesiologists and to respond based on practice pattern in the past year.
Results: The response rate was 22/128 (17%), with 20/128 (16%) considered complete. Of the 20 surgeons submitting complete surveys, 10 (50%) follow specific preoperative protocols, 9 (45%) follow intraoperative, and 8 (40%) follow postoperative protocols to minimize blood transfusion. 3 (15%) report having used erythropoietin. 9 (45%) at least occasionally use pre-operative autologous blood transfusion. 7 (35%) use antifibrinolytics. 3 (15%) use tranexamic acid; 3 (15%) use aminocaproic acid and 1 uses both. The most commonly reported EBL is 100-199cc per case (55%) followed by 200-299cc per case (35%). The most common intraoperative transfusion threshold reported is 7 g/dL hemoglobin (40%) in patients without signs or symptoms of instability. 1 (5%) reported no intra-operative transfusions, and all (100%) reported at least one post-op transfusion.
Conclusion: This survey highlights variations in blood conservation practices during cranial vault remodeling. About half of the respondents have protocols for peri-operative blood conservation. Given the frequency of transfusion and variety of strategies, further research is required to provide evidence-based guidelines.
