Minimizing transfusion requirements for children undergoing craniosynostosis repair: the CHoR protocol

Vega, Rafael A.; Lyon, Camila; Kierce, Jeannette; Tye, Gary; Ritter, Ann M.; Rhodes, Jennifer

doi:10.3171/2014.4.peds13449

Cited by 41 publications

(30 citation statements)

References 38 publications

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“…18,29 For this reason, it is important to reduce the transfusion rate in the endoscopic as well as in the open remodeling procedures. Because dilution may play an important role in the drop in postoperative hemoglobin level, 9 and a very strict protocol for the administration of intravenous fluids postoperatively was incorporated in 2012, resulting in a significant decline in transfusion rate to 7.7% in EACS-treated patients.…”

mentioning

confidence: 99%

Intraoperative and postoperative complications in the surgical treatment of craniosynostosis: minimally invasive versus open surgical procedures

Arts¹,

Delye²,

Lindert³

2018

Journal of Neurosurgery: Pediatrics

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OBJECTIVETo compare minimally invasive endoscopic and open surgical procedures, to improve informed consent of parents, and to establish a baseline for further targeted improvement of surgical care, this study evaluated the complication rate and blood transfusion rate of craniosynostosis surgery in our department.METHODSA prospective complication registration database that contains a consecutive cohort of all pediatric neurosurgical procedures in the authors’ neurosurgical department was used. All pediatric patients who underwent neurosurgical treatment for craniosynostosis between February 2004 and December 2014 were included. In total, 187 procedures were performed, of which 121 were endoscopically assisted minimally invasive procedures (65%). Ninety-three patients were diagnosed with scaphocephaly, 50 with trigonocephaly, 26 with plagiocephaly, 3 with brachycephaly, 9 with a craniosynostosis syndrome, and 6 patients were suffering from nonsyndromic multisutural craniosynostosis.RESULTSA total of 18 complications occurred in 187 procedures (9.6%, 95% CI 6.2–15), of which 5.3% (n = 10, 95% CI 2.9–10) occurred intraoperatively and 4.2% (n = 8, 95% CI 2.2–8.2) occurred postoperatively. In the open surgical procedure group, 9 complications occurred: 6 intraoperatively and 3 postoperatively. In the endoscopically assisted procedure group, 9 complications occurred: 4 intraoperatively and 5 postoperatively. Blood transfusion was needed in 100% (n = 66) of the open surgical procedures but in only 21% (n = 26, 95% CI 15–30) of the endoscopic procedures. One patient suffered a transfusion reaction, and 6 patients suffered infections, only one of which was a surgical site infection. A dural tear was the most common intraoperative complication that occurred (n = 8), but it never led to postoperative sequelae. Intraoperative bleeding from a sagittal sinus occurred in one patient with only minimal blood loss. There were no deaths, permanent morbidity, or neurological sequelae.CONCLUSIONSComplications during craniosynostosis surgery were relatively few and minor and were without permanent sequelae in open and in minimally invasive procedures. The blood transfusion rate was significantly reduced in endoscopic procedures compared with open procedures.

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mentioning

confidence: 99%

Intraoperative and postoperative complications in the surgical treatment of craniosynostosis: minimally invasive versus open surgical procedures

Arts¹,

Delye²,

Lindert³

2018

Journal of Neurosurgery: Pediatrics

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“…19,39 Although there appears to be low use of intraoperative transfusion algorithms in CFR patients, recent publications have associated the use of protocols with decreased transfusion. 6,32,35 Furthermore, experts in the field recommend transfusion protocols as a first-line approach to safely minimize transfusion in these patients. 33 Surgical technique changes were not novel but only focused on reducing unnecessary blood loss during skin opening and craniotomy, similar to those used on all infants undergoing craniotomy or neurosurgical intervention at our institution since late 2012.…”

Section: Discussionmentioning

confidence: 99%

Use of blood-sparing surgical techniques and transfusion algorithms: association with decreased blood administration in children undergoing primary open craniosynostosis repair

Nguyen¹,

Hill

Austin³

et al. 2015

PED

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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.

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“…Recent studies have reported a decline in perioperative transfusions over the past two decades for many surgical procedures in adults . Similarly, an observational study in adults undergoing LT demonstrated a reduction in blood and blood product transfusions over the years .…”

Section: Introductionmentioning

confidence: 95%

Trends in transfusion practice over 20 years in paediatric liver transplant programme

et al. 2019

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Background We investigated changes to transfusion practices over time in paediatric liver transplant centre and evaluated the effect of transfusion practice to mortality.Methods A pilot retrospective study included two cohorts each with 101 sequential paediatric LT recipients: an Early group (1994)(1995)(1996)(1997)(1998) and a Recent group (2009)(2010)(2011)(2012)(2013). Demographic characteristics and data on the intraoperative transfusion of red blood cells (RBC), fresh-frozen plasma (FFP), platelets and cryoprecipitate were collected. Postoperative laboratory results were also obtained, together with donor and data regarding 1-and 5-year survival. Appropriate intergroup comparisons, univariate and multivariate analysis were made and P ≤ 0Á05 was considered statistically significant.Results There were no significant group differences in demographic data (except patient height). Despite the fact that median total blood loss did not differ between groups (111 ml/kg in both groups), the Early group had greater levels of intraoperative RBC transfusion (75 vs. 59 ml/kg, respectively, P = 0Á04) and less use of FFP (53 vs. 62 ml/kg, respectively, P = 0Á01). Overall we noted a lower 1and 5-year survival in the Early group (88Á2% vs. 96%, P = 0Á04 and 82Á4% vs. 89Á1%, P = 0Á01, respectively). Univariate, but not multivariate regression analyses demonstrated that higher PELD score, RBC and FFP transfusion, and inclusion in the Early group were contributing factors to 1-year higher mortality.Conclusions This retrospective analysis of blood loss and replacement in paediatric LT patients demonstrates that the majority of our patients suffer major haemorrhage and require large-volume RBC and FFP replacements. In our pilot study, large volume of RBC and FFP replacement did not contribute to mortality. Paediatric LT involves a number of multidisciplinary teams. Thus, all care-related factors and combinations thereof that may contribute to outcome and should be evaluated in the future.

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Minimizing transfusion requirements for children undergoing craniosynostosis repair: the CHoR protocol

Cited by 41 publications

References 38 publications

Intraoperative and postoperative complications in the surgical treatment of craniosynostosis: minimally invasive versus open surgical procedures

Intraoperative and postoperative complications in the surgical treatment of craniosynostosis: minimally invasive versus open surgical procedures

Use of blood-sparing surgical techniques and transfusion algorithms: association with decreased blood administration in children undergoing primary open craniosynostosis repair

Trends in transfusion practice over 20 years in paediatric liver transplant programme

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