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Intra- and Postoperative Blood Loss and Transfusion Requirements in Children Undergoing Craniofacial Surgery

D’Amore, Alexander Lindholm MD*; Rasmussen, Mads MD, PhD*; Christensen, Leif MD; von Oettingen, Gorm MD, PhD; Nørholt, Sven Erik DDS, PhD; Krogh, Lisbeth MD*; Hvas, Anne-Mette MD§,||; Juul, Niels MD*; Fenger-Eriksen, Christian MD, PhD*

doi: 10.1097/SCS.0000000000005492
Clinical Study: PDF Only

Pediatric craniosynostosis (CS) surgery is frequently associated with extensive blood loss and transfusion requirements. The aim of the study was to evaluate the authors’ institutional procedure with 2-surgeon approach and early transfusion strategy on blood loss and blood product transfusions in children undergoing craniofacial surgery. A retrospective analysis of medical records was performed of pediatric CS corrections during a 15-year period. Primary endpoint was blood loss and transfusion requirement during and the following 24 hours postoperatively. Linear regression analyses were performed of associations between intra and- postoperative blood loss and blood loss and weight. A total of 276 children (median 9 months) were included. Intraoperative blood loss was 22 mL/kg (14–33 mL/kg) and postoperatively 27 mL/kg (18–37 mL/kg), with no change during the study period. Intraoperative transfusions of red blood cell and plasma were 16 mL/kg (10–24 mL/kg) and postoperative 14 mL/kg (9–21 mL/kg). Postoperative red blood cell and plasma transfusions were 2 mL/kg (0–6 mL/kg) and of 0 mL/kg, respectively. Craniosynostosis type was related to blood loss (P < 0.001). There was an association between intraoperative and postoperative blood loss (P = 0.012) and intra- and postoperative blood loss and weight (P = 0.002, P = < 0.001). Duration of surgery was 110 minutes (range 60–300 minutes).

Pediatric CS surgery is associated with substantial intra- and postoperative blood loss and transfusion requirements, which did not change over a 15-year period. Blood loss was associated with type of CS. Intraoperative blood loss was correlated to postoperative blood loss and body weight.

*Department of Anaesthesiology

Department of Neurosurgery

Department of Oral and Maxillofacial Surgery

§Department of Clinical Biochemistry, Center for Haemophilia and Thrombosis, Aarhus University Hospital

||Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.

Address correspondence and reprint requests to Alexander Lindholm D’Amore, MD, Department of Anaesthesiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard, DK-8200 Aarhus N, Denmark; E-mail:

Received 3 October, 2018

Accepted 18 February, 2019

Source of funding: The study from Novo Nordisk Fonden (NNF14OC0011787).

The authors report no conflicts of interest.

© 2019 by Mutaz B. Habal, MD.