title: Intraoperative optimization to decrease postoperative PRBC transfusion in children undergoing craniofacial reconstruction.
abstract: BACKGROUND
  Craniofacial reconstructive surgery for craniosynostosis is associated with large blood loss and intraoperative transfusion. This blood loss may continue through the initial postoperative period, potentially resulting in transfusion postoperatively. The purpose of this study is to determine if there is an association between any modifiable intraoperative factors and postoperative blood transfusion in this patient population.
  
  
  METHODS
  A cohort of 55 pediatric patients who underwent primary craniofacial reconstruction at Vanderbilt Children's Hospital from January 1, 2013 to April 31, 2014 was analyzed. The authors analyzed 20 different demographic and perioperative variables for statistical associations with postoperative PRBC transfusion using multiple logistic regression with optimal models being selected by Bayesian model averaging.
  
  
  RESULTS
  The optimal regression model only included initial PACU Hct as a predictor and showed a significant association between this variable and postoperative PRBC transfusion (odds ratio 0.69, 95% CI 0.55-0.87, P = 0.0016). Based on the average decrease in postoperative hematocrit (Hct) and the postoperative transfusion trigger, an initial PACU Hct threshold of 30 was calculated. In our patient sample, an initial PACU Hct above 30 was associated with a 50% decrease in the absolute risk of receiving a PRBC transfusion postoperatively.
  
  
  CONCLUSIONS
  Based on this retrospective analysis, it may be justifiable to transfuse residual volume from previously exposed intraoperative PRBCs to a Hct above 30 to decrease the likelihood of subsequent blood transfusions from different donors in the postoperative period.
authors.affiliation: Division of Pediatric Anesthesiology, Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: Thanh T
authors.initials: TT
authors.lastname: Nguyen
authors.forename: Humphrey V
authors.initials: HV
authors.lastname: Lam
authors.forename: Maxie
authors.initials: M
authors.lastname: Phillips
authors.forename: Clasherrol
authors.initials: C
authors.lastname: Edwards
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Austin
mesh_terms: D000768:Anesthesia, General; D019465:Craniofacial Abnormalities / Q000601:surgery*; D017707:Erythrocyte Transfusion / Q000379:methods*; D005260:Female; D006400:Hematocrit; D006801:Humans; D007223:Infant; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D011182:Postoperative Care; D011183:Postoperative Complications / Q000517:prevention & control*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013580:Synostosis / Q000601:surgery
keywords: blood loss; coagulopathy; craniofacial reconstruction; craniosynostosis; immunomodulation; transfusion