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Minimizing transfusion in sagittal craniosynostosis surgery: the Children’s Hospital of Minnesota Protocol

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Abstract

Purpose

To assess the success of a protocol using preoperative erythropoietin (EPO) and iron with perioperative tranexamic acid (TXA) in reducing blood transfusion in sagittal craniosynostosis surgery.

Methods

A retrospective chart review of all sagittal craniosynostosis patients undergoing open repair at our institution since 2010 was conducted. A novel protocol of preoperative EPO with iron and perioperative TXA, along with a shift away from automatic transfusion, was initiated in 2014. Perioperative hemoglobin levels, length of stay, and transfusion rates were compared between the historical control and the study group receiving the protocol.

Results

A total of 36 patients met inclusion criteria. Twenty-eight patients were male and 8 were female. Twenty-two patients were in the control group receiving neither TXA nor EPO and automatically received a transfusion, while 14 were in the study group and received the full protocol. There were no significant demographic differences between groups. Within the control group, 100% of patients were transfused compared with 14.3% of the study group (p < 0.0001). The study group also had a shorter postoperative length of stay in the hospital (mean, 3.4 days; range, 3–6) than the control (mean, 4 days; range, 2–5.5, p = 0.038). The study group had a higher preoperative hemoglobin than the control (13.6 vs. 11.8 g/dL, p = 0.0001).

Conclusion

Our protocol of preoperative EPO and iron with perioperative TXA increased the preoperative hemoglobin and was associated with a low transfusion rate without negatively impacting postoperative course.

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References

  1. Aljaaly HA, Aldekhayel SA, Diaz-Abele J, Karunanayka M, Gilardino MS (2017) Effect of erythropoietin on transfusion requirements for craniosynostosis surgery in children. J Craniofac Surg 28:1315–1319

    Article  PubMed  Google Scholar 

  2. Beno S, Ackery AD, Callum J, Rizoli S (2014) Tranexamic acid in pediatric trauma: why not? Crit Care 18:313

    Article  PubMed  PubMed Central  Google Scholar 

  3. Bergquist CS, Nauta AC, Selden NR, Kuang AA (2016) Age at the time of surgery and maintenance of head size in nonsyndromic sagittal craniosynostosis. Plast Reconstr Surg 137:1557–1565

    Article  CAS  PubMed  Google Scholar 

  4. Bierer R, Roohl M, Ohls RK (2009) Erythopoietin increases reticulocyte counts and maintains hematocrit in neonates requiring surgery. J Pediatr Surg 44(8):1540–1545

    Article  PubMed  PubMed Central  Google Scholar 

  5. Chan JW, Stewart CL, Stalder MW, St Hilaire H, McBride L, Moses MH (2013) Endoscope-assisted open repair of craniosynostosis: a comparison of perioperative cost and risk. J Craniofac Surg 24(1):170–174

    Article  PubMed  Google Scholar 

  6. Dadure C, Sauter M, Bringuier S, Bigorre M, RAux O, Rochette A, Canaud N, Capdevila X (2011) Intraoperative tranexamic acid reduces blood transfusion in children undergoing craniosynostosis surgery. Anesthesiology 114:856–861

    Article  CAS  PubMed  Google Scholar 

  7. DiRocco F, Arnaud E, Renier D (2009) Evolution in the frequency of nonsyndromic craniosynostosis. J Neurosurg Pediatr 4:21–25

    Article  Google Scholar 

  8. Faberowski LW, Black S, Mickle JP (1999) Blood loss and transfusion practice in the perioperative management of craniosynostosis repair. J Neurosurg Anesthesiol 11(3):167–172

    Article  CAS  PubMed  Google Scholar 

  9. Fearon JA, Weinthal J (2002) The use of recombinant erythropoietin in the reduction of blood transfusion rates in craniosynostosis repair in infants and children. Plast Reconstr Surg 109:2190–2196

    Article  PubMed  Google Scholar 

  10. Goobie SM, Haas T (2014) Bleeding management for pediatric craniotomies and craniofacial surgery. Pediatr Anesth 24:679–689

    Google Scholar 

  11. Goobie SM, Meier PM, Pereira LM, McGowan FX, Prescilla RP, Scharp LA, Rogers GF, Proctor MR, Meara JG, Soriano SG, Zurakowski D, Sethna NF (2011) Efficacy of tranexamic acid in pediatric craniosynostosis surgery: a double-blind, placebo-controlled trial. Anesthesiology 114(4):862–871

    Article  CAS  Google Scholar 

  12. Goodnough LT, Monk TG, Adriole GL (1997) Erythropoietin therapy. N Engl J Med 336:933–938

    Article  CAS  PubMed  Google Scholar 

  13. Helfaer MA, Carson BS, James CS, Gate J, Della-Lana D, Vander Kolk C (1998) Increased hematocrit and decreased transfusion requirements in children given erythropoietin before undergoing craniofacial surgery. J Neurosurg 88(4):704–708

    Article  CAS  PubMed  Google Scholar 

  14. Hunt BJ (2015) The current place of tranexamic acid in the management of bleeding. Anaesthesia 70:50–53

    Article  CAS  PubMed  Google Scholar 

  15. Kucuk A, Tumturk A, Gergin IS, Oral S, Gorkem SB, Kurtsoy A, Madenoglu H, Oktem IS (2017) The management of blood loss in non-syndromic craniosynostosis patients undergoing barrel stave osteotomy. Turk Neurosurg 27(1):138–141

    PubMed  Google Scholar 

  16. Martin JP, Wang JS, Hanna KR, Stovall MM, Lin KY (2015) Use of tranexamic acid in craniosynostosis surgery. Plast Surg 23(4):247–251

    Article  Google Scholar 

  17. Meyer P, Renier D, Arnaud E, Jarreau MM, Charron B, Buy E, Buisson C, Barrier G (1993) Blood loss during repair of craniosynostosis. Br J Anaesth 71:854–857

    Article  CAS  PubMed  Google Scholar 

  18. Naran S, Cladis F, Fearon J, Bradley J, Michelotti B, Cooper G, Cray J, Katchikian H, Grunwaldt L, Pollack IF, Losee J (2012) Safety of preoperative erythropoietin in surgical calvarial remodeling: an 8 year retrospective review and analysis. Plast Reconstr Surg 130:301–305

    Article  Google Scholar 

  19. Okada H, Gosain AK (2012) Current approaches to management of nonsyndromic craniosynostosis. Curr Opin Otolaryngol Head Neck Surg 20(4):310–317

    Article  PubMed  Google Scholar 

  20. Pagnoni M, Fadda MT, Spalice A, Amodeo G, Ursitti F, Mitro V, Iannetti G (2014) Surgical timing of craniosynostosis: what to do and when. J Craniomaxillofac Surg 42(5):513–519

    Article  PubMed  Google Scholar 

  21. Parker RI (2014) Transfusion in critically ill children: indications, risks, and challenges. Crit Care Med 42(3):675–690

    Article  PubMed  Google Scholar 

  22. Rothermel LD, Lipman JM (2016) Estimation of blood loss is inaccurate and unreliable. Surgery 160(4):946–953

    Article  PubMed  Google Scholar 

  23. Song G, Yang P, Zhu S, Luo E, Feng G, Hu J, Li J, Li Y (2013) Tranexamic acid reducing blood transfusion in children ungergoing craniosynostosis surgery. J Craniofac Surg 24:299–303

    Article  PubMed  Google Scholar 

  24. Teichgraeber JF, Baumgartner JE, Waller AL, Reis SM, Stafford MT, Hollinger LE (2009) Microscopic minimally invasive approach to nonsyndromic craniosynostosis. J Craniofac Surg 20:1492–1500

    Article  PubMed  Google Scholar 

  25. Tran DH, Wong GT, Chee YE, Irwin MG (2014) Effectiveness and safety of erythropoiesis stimulating agent use in the perioperative period. Expert Opin Biol Ther 14:51–61

    Article  CAS  PubMed  Google Scholar 

  26. Velardi F, DiChirico A, DiRocco C, Fundarè C, Genovese O, Rendeli C, Menichella G, Serafini R, Piastra M, Viola L, Pietrini D, Pusateri A, Stoppa F (1998) “No allogeneic blood transfusion” protocol for the surgical correction of craniosynostosis. Childs Nerv Syst 14:732–739

    Article  CAS  PubMed  Google Scholar 

  27. Velardi F, DiChirico A, DiRocco C (1999) Blood salvage in craniosynostosis surgery. Childs Nerv Syst 15:695–710

    Article  CAS  PubMed  Google Scholar 

  28. Vergnaud E, Vecchione A, Blanot S, di Rocco F, Arnaud E, Renier D, Meyer P (2012) Reducing blood losses and transfusion requirements in craniosynostosis surgery: an endless quest? Anesthesiology 116:733–734

    Article  PubMed  Google Scholar 

  29. White N, Bayliss S, Lib D, Moore D (2015) Systematic review of interventions for minimizing perioperative blood transfusion for surgery for craniosynostosis. J Craniofac Surg 26:26–36

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors would like to acknowledge Margaret Kurth, MD, of the Children’s Minnesota Center for Bleeding and Clotting Disorders for her significant contributions to the conception and design of this protocol.

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Authors and Affiliations

  1. University of Minnesota Medical School, Minneapolis, MN, USA

    Paul J. Escher & Matthew Wheelwright

  2. Children’s Minnesota Department of Neurosurgery, Minneapolis, MN, USA

    Albert Tu, Joseph Petronio & Meysam Kebriaei

  3. Children’s Minnesota Center for Bleeding and Clotting Disorders, Minneapolis, MN, USA

    Susan Kearney

  4. Children’s Minnesota ENT and Craniofacial Surgery, Minneapolis, MN, USA

    Sivakumar Chinnadurai & Robert J. Tibesar

Authors
  1. Paul J. Escher
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  2. Albert Tu
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Correspondence to Robert J. Tibesar.

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Escher, P.J., Tu, A., Kearney, S. et al. Minimizing transfusion in sagittal craniosynostosis surgery: the Children’s Hospital of Minnesota Protocol. Childs Nerv Syst 35, 1357–1362 (2019). https://doi.org/10.1007/s00381-019-04157-5

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  • DOI: https://doi.org/10.1007/s00381-019-04157-5

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