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Factors Related to Blood Loss During Fronto-Orbital Advancement

Seruya, Mitchel MD*; Oh, Albert K. MD; Rogers, Gary F. MD, JD, MBA, MPH; Boyajian, Michael J. MD; Myseros, John S. MD; Yaun, Amanda L. MD; Keating, Robert F. MD

Journal of Craniofacial Surgery: March 2012 - Volume 23 - Issue 2 - p 358–362
doi: 10.1097/SCS.0b013e31824b9c45
Original Articles

Background Blood loss during fronto-orbital advancement (FOA) remains a significant potential source of morbidity. This study explored variables that might correlate with calculated blood loss (CBL) during this procedure.

Methods The authors reviewed infants with craniosynostosis who underwent primary FOA (1997–2009). Patient demographics, operative time, and mean arterial pressure (MAP) were recorded. Serial MAPs were averaged for a MAPmean and subtracted from preoperative baseline to calculate MAP%decrease. This provided indicators of both absolute and relative hypotension, respectively. Calculated blood loss was based on preoperative/postoperative hemoglobin values and transfusion volumes and accounted for hemodilutional effects.

Results Ninety infants underwent FOA at an average age of 10.7 ±12.9 months and mean weight of 9.0 ± 7.0 kg. Average operative time was 4.2 hours, and intraoperative MAP was 56.1 mm Hg, 22.6% lower than baseline. Mean CBL was 259.3 mL, or 39.3% of estimated blood volume, negatively correlating with surgical age (r = −0.033, P < 0.05) and positively trending with operative time (r = 0.55, P < 0.05). Absolute hypotension was associated with greater blood loss, as demonstrated by an inverse relationship between CBL and MAPmean (r = −0.19, P < 0.05). From the perspective of relative hypotension, no association was found between CBL and MAP%decrease.

Conclusions Greater operative efficiency and deferring operative correction to a later age may diminish blood loss during FOA. The study results also raise serious concerns regarding the hemodynamic benefits of controlled systemic hypotension.

From the *Department of Plastic Surgery, Georgetown University Hospital; Departments of †Plastic and Reconstructive Surgery, and ‡Neurosurgery at Children’s National Medical Center, Washington, District of Columbia.

Received August 11, 2011.

Accepted for publication November 20, 2011.

Address correspondence and reprint requests to Robert F. Keating, MD, Department of Neurosurgery, Children’s National Medical Center, 111 Michigan Ave NW, 4th Floor, West Wing, Washington, DC 20010; E-mail:

The authors report no conflict of interest.

© 2012 Mutaz B. Habal, MD