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Minimizing blood transfusions in the surgical correction of coronal and metopic craniosynostosis

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Abstract

Objective

The current study was performed to determine the rate of allogeneic blood transfusion for coronal and metopic craniosynostosis surgery done by two experienced pediatric neurosurgeons and to identify factors associated with a need for transfusion.

Methods

First operations for coronal and metopic craniosynostosis correction in children from 1996 to 2002 were reviewed retrospectively. For analysis, the primary endpoint was defined as either the receipt of a blood transfusion or a postoperative Hb level below 70 g/l, even if no blood was transfused. Univariate and multivariate analyses were done to examine the relationship of attaining the primary endpoint to extent of surgery, surgeons, surgery time, preoperative hemoglobin, craniosynostosis type, weight, and age.

Results

Thirty-two patients were operated on: 17 with unicoronal; 9 with bicoronal, and 6 with metopic craniosynostosis. Median age at operation was 7.5 months. Blood transfusion rates were 0% for unicoronal, 44% for bicoronal, and 33% for metopic synostosis operations. Logistic regression revealed that the best predictor of having a postoperative hemoglobin level of <70 g/l or receiving a blood transfusion was the extent of surgery (β=1.59, SE β =0.57). The odds of reaching the primary endpoint for extensive surgery over basic surgery was 4.9 [95%CI=(1.6,15.0)]. Once extent of surgery was accounted for in the model, no other covariates significantly improved the model.

Conclusions

Low transfusion rates were achieved in primary operations for coronal and metopic craniosynostosis using simple intraoperative techniques and by accepting a low postoperative hemoglobin level.

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Acknowledgments

We wish to thank Farouk Nathoo at the Children’s and Women’s Health Center statistical consulting unit, for performing and consulting on the statistical analyses.

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Authors and Affiliations

  1. Division of Pediatric Neurosurgery, Department of Surgery, University of British Columbia and British Columbia’s Children’s Hospital, 4480 Oak Street, Vancouver, BC, Canada, V6H 3V4

    Paul Steinbok, Navraj Heran, Tufan Hicdonmez, D. Douglas Cochrane & Angela Price

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  1. Paul Steinbok
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  2. Navraj Heran
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  3. Tufan Hicdonmez
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  4. D. Douglas Cochrane
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  5. Angela Price
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Correspondence to Paul Steinbok.

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Steinbok, P., Heran, N., Hicdonmez, T. et al. Minimizing blood transfusions in the surgical correction of coronal and metopic craniosynostosis. Childs Nerv Syst 20, 445–452 (2004). https://doi.org/10.1007/s00381-004-0972-9

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  • DOI: https://doi.org/10.1007/s00381-004-0972-9

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