title: Use of blood-sparing surgical techniques and transfusion algorithms: association with decreased blood administration in children undergoing primary open craniosynostosis repair.
abstract: OBJECT Craniofacial reconstruction surgery (CFR) is often associated with significant blood loss, coagulopathy, and perioperative blood transfusion. Due to transfusion risks, many different approaches have been used to decrease allogeneic blood transfusion for these patients during the perioperative period. Protocols have decreased blood administration during the perioperative period for many types of surgeries. The object of this study was to determine if a protocol involving blood-sparing surgical techniques and a transfusion algorithm decreased intraoperative blood transfusion and blood loss. METHODS A protocol using transfusion algorithms and implementation of blood-sparing surgical techniques for CFR was implemented at Vanderbilt University on January 1, 2013. Following Institutional Review Board approval, blood loss and transfusion data were gathered retrospectively on all children undergoing primary open CFR, using the protocol, for the calendar year 2013. This postprotocol cohort was compared with a preprotocol cohort, which consisted of all children undergoing primary open CFR during the previous calendar year, 2012. RESULTS There were 41 patients in the preprotocol and 39 in the postprotocol cohort. There was no statistical difference between the demographics of the 2 groups. When compared with the preprotocol cohort, intraoperative packed red blood cell transfusion volume decreased from 36.9 ± 21.2 ml/kg to 19.2 ± 10.9 ml/kg (p = 0.0001), whereas fresh-frozen plasma transfusion decreased from 26.8 ± 25.4 ml/kg to 1.5 ± 5.7 ml/kg (p < 0.0001) following implementation of the protocol. Furthermore, estimated blood loss decreased from 64.2 ± 32.4 ml/kg to 52.3 ± 33.3 ml/kg (p = 0.015). Use of fresh-frozen plasma in the postoperative period also decreased when compared with the period before implementation of the protocol. There was no significant difference in morbidity and mortality between the 2 groups. CONCLUSIONS The results of this study suggested that using a multidisciplinary protocol consisting of transfusion algorithms and implementation of blood-sparing surgical techniques during major CFR in pediatric patients is associated with reduced intraoperative administration of blood product, without shifting the transfusion burden to the postoperative period.
authors.affiliation: Departments of 1 Anesthesiology.
authors.forename: Thanh T
authors.initials: TT
authors.lastname: Nguyen
authors.affiliation: Nursing, and.
authors.forename: Sarah
authors.initials: S
authors.lastname: Hill
authors.affiliation: Departments of 1 Anesthesiology.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Austin
authors.affiliation: Department of Anesthesiology, University of Colorado, Aurora, Colorado.
authors.forename: Gina M
authors.initials: GM
authors.lastname: Whitney
authors.affiliation: Neurosurgery and Pediatrics, Vanderbilt University, Nashville, Tennessee; and.
authors.forename: John C
authors.initials: JC
authors.lastname: Wellons
authors.affiliation: Departments of 1 Anesthesiology.
authors.forename: Humphrey V
authors.initials: HV
authors.lastname: Lam
keywords: ASA = American Society of Anesthesiologists; CFR = craniofacial reconstruction surgery; EBL = estimated blood loss; FFP = fresh-frozen plasma; INR = international normalized ratio; PCV = packed cell volume; PRBC = packed red blood cells; ROTEM = rotation thrombelastometry; TEG = thromboelastography; blood-sparing surgical techniques; craniosynostosis; fresh-frozen plasma; protocol; technique; thromboelastography; transfusion