title: Factors influencing blood loss and postoperative morbidity in children undergoing craniosynostosis surgery: a retrospective study.
abstract: BACKGROUND
  Craniosynostosis is a condition resulting from the premature fusion of cranial sutures. Corrective surgery is often associated with a large amount of blood loss, with transfusion of red blood cells (RBC) and fresh frozen plasma (FFP). The aims of this study were to determine the variables associated with increased blood loss and postoperative complications.
  
  
  METHODS
  A retrospective analysis was performed of 42 pediatric patients who underwent craniosynostosis surgery. We analyzed the following: demographic parameters, duration of surgery, intraoperative blood loss, RBC, FFP and fluid transfusion, urine output, and hemodynamic parameters. In addition, we recorded the postoperative length of stay in the intensive care unit and hospital, postoperative blood loss and early complications.
  
  
  RESULTS
  The mean age, weight and surgical duration were 9.2 ± 3.2 months, 9.3 ± 2.0 kg and 255.8 ± 46.7 min, respectively. Intraoperative blood loss was 61.2 ± 15.3 ml/kg and RBC, FFP and fluid transfusion were 27.3 ± 7.1 ml/kg, 16.5 ± 4.7 ml/kg and 21.7 ± 4.6 ml/kg/h, respectively. Greater intraoperative blood loss was associated with longer surgical duration (p = 0.001, correlation coefficient = 0.495, R2 = 0.245) and lower patient weight (p < 0.001, correlation coefficient = -0.557, R2 = 0.311). Longer hospital stay was associated with greater intraoperative blood loss (p < 0.001, correlation coefficient = 0.754, R2 = 0.568) and greater intraoperative RBC transfusion (p < 0.001, correlation coefficient = 0.795, R2 = 0.632).
  
  
  CONCLUSIONS
  Severe blood loss occurred in all children who underwent craniosynostotic corrections. Furthermore, the duration of surgery, patient weight and certain surgical procedures correlated with greater blood loss. Careful hemodynamic monitoring and evaluation of a patient's hematocrit value and volume status together may be helpful in maintaining the balance between insufficient and excessive blood product transfusion.
authors.forename: Achmet
authors.initials: A
authors.lastname: Ali
authors.forename: Burcu
authors.initials: B
authors.lastname: Basaran
authors.forename: Mesut
authors.initials: M
authors.lastname: Yornuk
authors.forename: Demet
authors.initials: D
authors.lastname: Altun
authors.forename: Aydin
authors.initials: A
authors.lastname: Aydoseli
authors.forename: Altay
authors.initials: A
authors.lastname: Sencer
authors.forename: I Ozkan
authors.initials: IO
authors.lastname: Akinci
mesh_terms: D016063:Blood Loss, Surgical / Q000503:physiopathology* / Q000706:statistics & numerical data; D003398:Craniosynostoses / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology* / Q000652:urine; D012189:Retrospective Studies