Effect of transfusion guidelines on postoperative transfusion in children undergoing craniofacial reconstruction surgery.
OBJECTIVE
To assess the effect of implementation of population-specific postoperative management guidelines on postoperative transfusion in children undergoing cranial vault reconstruction surgery.


METHODS
Retrospective observational study with historical controls.


METHODS
Single, large, academic tertiary pediatric hospital.


METHODS
: Children aged 6 months to 17 yrs undergoing fronto-orbital advancement or posterior cranial vault reconstruction surgery enrolled in our craniofacial surgery perioperative registry from April 14, 2008 to September 7, 2011.


METHODS
Postoperative management guidelines for children undergoing cranial vault reconstruction surgery were implemented on December 1, 2009. These management guidelines included projected surgical drain output as well as specific transfusion thresholds for packed red blood cells and hemostatic blood products.


RESULTS
We queried our craniofacial surgery perioperative registry for children who underwent cranial vault reconstruction to assess transfusion practices before and after the implementation of the postoperative guidelines. Subjects were divided into a preguideline cohort and a postguideline cohort. Perioperative demographic data and postoperative transfusion data were compared between the two groups. The registry query returned data on 59 procedures in the preguideline cohort and 58 procedures in the postguideline cohort. The immediate postoperative hematocrit and the postoperative blood loss through surgical drains were not statistically different in the two groups. The prevalence of postoperative transfusion of any blood product was significantly less in the postguideline cohort (17% vs. 42%, p = .003). Most of the transfusion reduction was achieved through a reduction in fresh frozen plasma transfusion (5% vs. 25%, p = .002).


CONCLUSIONS
In this observational study, the implementation of postoperative management guidelines was associated with a 60% reduction in postoperative transfusion. The use of transfusion thresholds is a simple, inexpensive, and effective strategy for transfusion reduction and should be a first-line approach to perioperative transfusion reduction in this population.
Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. strickerp@email.chop.edu
Paul A
PA
Stricker
John E
JE
Fiadjoe
Todd J
TJ
Kilbaugh
Eric Y
EY
Pruitt
Jesse A
JA
Taylor
Scott P
SP
Bartlett
John J
JJ
McCloskey
D000168:Acrocephalosyndactylia / Q000601:surgery; D001803:Blood Transfusion / Q000592:standards* / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003398:Craniosynostoses / Q000601:surgery*; D004322:Drainage; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006439:Hemodynamics; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007223:Infant; D019934:International Normalized Ratio; D008297:Male; D010314:Partial Thromboplastin Time; D010976:Platelet Count; D011182:Postoperative Care / Q000592:standards*; D017410:Practice Guidelines as Topic; D011517:Prothrombin Time; D019651:Plastic Surgery Procedures
D006454:Hemoglobins; D005340:Fibrinogen