title: Predictors of blood loss in fronto-orbital advancement and remodeling.
abstract: Fronto-orbital advancement and remodeling for craniosynostosis is extensive surgery and is associated with potential risks; the most significant of these is blood loss. We prospectively studied 116 consecutive patients undergoing fronto-orbital advancement by the same surgical team for a 5-year 6-month period to determine what factors are associated with blood loss and transfusion of blood products. The data collected on the calvarial sutures involved were whether the patient had a diagnosed syndrome, the age at operation, the length of the operation, the estimated blood volume lost during the perioperative course, the number of units of packed cells transfused (donor exposures), and the use of other blood products. The mean (SD) total blood volume lost was 116% (5.4) of the estimated preoperative volume. The median number of whole units of packed cells transfused was 2 units. Other blood products were given in 28% of the cases. There was significantly greater blood loss in those patients with recognized craniofacial syndromes, pansynostosis, an operating time longer than 5 hours, and an age of 18 months or younger at operation. The use of other blood products was associated with those patients losing a blood volume higher than the mean.
authors.affiliation: Department of Anaesthesia, Birmingham Children's Hospital, Birmingham, United Kingdom. nicholas.white@bch.nhs.uk
authors.forename: Nicholas
authors.initials: N
authors.lastname: White
authors.forename: Ritchie
authors.initials: R
authors.lastname: Marcus
authors.forename: Stephen
authors.initials: S
authors.lastname: Dover
authors.forename: Guirish
authors.initials: G
authors.lastname: Solanki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nishikawa
authors.forename: Carol
authors.initials: C
authors.lastname: Millar
authors.forename: Edmund D
authors.initials: ED
authors.lastname: Carver
mesh_terms: D000367:Age Factors; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D001802:Blood Substitutes / Q000627:therapeutic use; D001803:Blood Transfusion / Q000706:statistics & numerical data; D001804:Blood Transfusion, Autologous / Q000706:statistics & numerical data; D001810:Blood Volume; D002648:Child; D002675:Child, Preschool; D019465:Craniofacial Abnormalities / Q000601:surgery*; D003398:Craniosynostoses / Q000145:classification / Q000601:surgery; D000077324:Crystalloid Solutions; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D004911:Erythrocyte Volume; D005169:Factor VIII / Q000627:therapeutic use; D005340:Fibrinogen / Q000627:therapeutic use; D005353:Fibronectins / Q000627:therapeutic use; D005544:Forecasting; D005624:Frontal Bone / Q000601:surgery*; D006400:Hematocrit; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007223:Infant; D007552:Isotonic Solutions / Q000627:therapeutic use; D009915:Orbit / Q000601:surgery*; D010314:Partial Thromboplastin Time; D010949:Plasma; D017713:Platelet Transfusion / Q000706:statistics & numerical data; D011446:Prospective Studies; D011517:Prothrombin Time; D019651:Plastic Surgery Procedures / Q000379:methods*; D013997:Time Factors
chemical_list: D001802:Blood Substitutes; D000077324:Crystalloid Solutions; D005353:Fibronectins; D006454:Hemoglobins; D007552:Isotonic Solutions; C026912:cryoprecipitate coagulum; D005169:Factor VIII; D005340:Fibrinogen