Blood Loss and Replacement for Paediatric Cranioplasty in Australia – A Prospective National Audit

We prospectively audited blood loss and blood replacement in every child less than 24 months of age undergoing cranioplasty for craniosynostosis in Australia during 2008, in order to obtain more accurate data for the discussion of perioperative transfusion risk. A total of 127 cases were performed a...

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Bibliographic Details
Published in:Anaesthesia and intensive care 2012-01, Vol.40 (1), p.107-113
Main Authors: Howe, P. W., Cooper, M. G.
Format: Article
Language:English
Subjects:
Anesthesia
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Australia
Biological and medical sciences
Blood Loss, Surgical
Blood transfusion
Blood Transfusion - methods
Children
Children's hospitals
Craniosynostoses - surgery
Craniotomy - methods
Humans
Infant
Laws, regulations and rules
Medical sciences
Methods
Prospective Studies
Risk
Services
Surgery
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Summary:We prospectively audited blood loss and blood replacement in every child less than 24 months of age undergoing cranioplasty for craniosynostosis in Australia during 2008, in order to obtain more accurate data for the discussion of perioperative transfusion risk. A total of 127 cases were performed at seven centres. There were no directed or autologous blood donations. No patient received preoperative erythropoietin. A total of 233 units of homologous red blood cells were transfused. Overall, 83% of patients received a blood transfusion. This included 100% of patients undergoing cranial vault reconstruction (CVR) and 98% of patients undergoing fronto-orbital advancement (FOA), but only 32% of spring cranioplasty patients. Exposure to no more than one donor was achieved in 60% of FOA patients and 36% of CVR patients. Estimated blood volume loss was more than one blood volume in 36% of CVR and 36% of FOA, but only 12% of spring cranioplasty, and more than two blood volumes in 4% of CVR and 11% of FOA. Differences in surgical technique and volume of surgery between different centres appeared to affect transfusion rates. Children with recognised craniofacial syndromes and those undergoing repeat surgery appeared to have greater blood loss and blood product exposure. There were two cases of sudden massive haemorrhage secondary to dural venous sinus tear, but no death or perioperative cardiac arrest. These findings indicate that blood loss requiring blood product replacement is common in patients
ISSN:0310-057X
1448-0271
DOI:10.1177/0310057X1204000111