Blood loss, replacement, and associated morbidity in infants and children undergoing craniofacial surgery.
BACKGROUND
Pediatric craniofacial reconstruction (CFR) procedures involve wide scalp dissections with multiple osteotomies and have been associated with significant morbidity. The aim of this study was to document the incidence of clinically important problems, particularly related to blood loss, and perform a risk factor analysis.


METHODS
Records of all patients who underwent craniofacial surgery at the Children's Hospital of Philadelphia between December 1, 2001 and January 1, 2006 were reviewed. Data were collected from the electronic anesthesia record, intensive care unit (ICU) progress notes, and discharge summary. All intraoperative laboratory values and all laboratory values obtained upon arrival in the ICU were recorded. A multivariable analysis was performed to evaluate associations between elements of intraoperative management and the following clinical outcomes: intraoperative hypotension, intraoperative metabolic acidosis, presence of a postoperative coagulation test abnormality, and postoperative administration of hemostatic blood products.


RESULTS
Data for 159 patients were reviewed. The mean volume of packed red blood cells transfused intraoperatively was 51 ml x kg(-1). Multivariable analysis revealed that intraoperative administration of albumin was strongly correlated with both an increased incidence of postoperative coagulation derangements and postoperative administration of hemostatic blood products (Odds Ratio 5.9, 2.8, respectively), while intraoperative fresh frozen plasma (FFP) administration was associated with an opposite effect (Odds Ratio 0.94, 0.97, respectively).


CONCLUSIONS
In pediatric CFR procedures where the volume of blood loss routinely exceeds one blood volume, intraoperative administration of FFP favorably impacted postoperative laboratory coagulation parameters.
Stricker
Paul A
PA
Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-4399, USA. strickerp@email.chop.edu
Shaw
Thomas L
TL
Desouza
Duncan G
DG
Hernandez
Stephanie V
SV
Bartlett
Scott P
SP
Friedman
David F
DF
Sesok-Pizzini
Deborah A
DA
Jobes
David R
DR
D000293:Adolescent; D000758:Anesthesia; D001772:Blood Cell Count; D001780:Blood Coagulation Tests; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D001802:Blood Substitutes / Q000627:therapeutic use*; D001803:Blood Transfusion; D002648:Child; D002675:Child, Preschool; D019465:Craniofacial Abnormalities / Q000601:surgery*; D003625:Data Collection; D004363:Drug Utilization; D004906:Erythrocyte Count; D005260:Female; D005440:Fluid Therapy; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications / Q000097:blood / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D015999:Multivariate Analysis; D019651:Plastic Surgery Procedures / Q000009:adverse effects; D012307:Risk Factors; D016896:Treatment Outcome
D001802:Blood Substitutes; D006490:Hemostatics