Comparison of perioperative blood salvage and postoperative reinfusion of drained blood during surgical correction of craniosynostosis in infants

Orliaguet, Gilles; Bruyère, M.; Meyer, Philippe; Blanot, Stéphane; Rénier, Dominique; Carli, Pierre

doi:10.1046/j.1460-9592.2003.01155.x

Cited by 32 publications

(20 citation statements)

References 32 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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“…Serious or fatal transfusion-related reactions occur in 3/10,000 units given. 26 Although blood products are routinely tested for infectious agents, there is still a risk of transmission of blood-borne infections such as HIV (1/200,000) and hepatitis B and C (1/30,000 for each virus). Risks also include bacterial contamination, acute hemolytic reactions (1/250,000), TRALI (1/5000), and TRIM.…”

Section: Discussionmentioning

confidence: 99%

“…Risks also include bacterial contamination, acute hemolytic reactions (1/250,000), TRALI (1/5000), and TRIM. 10,26 Studies have reported EBL as high as 60%-100% of estimated blood volume (EBV) with almost all patients undergoing a blood transfusion during or immediately after the surgery. 16,32,34 Our results were consistent with the high EBL presented in previous studies, with a 15 ml/kg average EBL (18% EBV) for the C group and 23.5 ml/kg (29% EBV) for the protocol group.…”

Section: Discussionmentioning

confidence: 99%

“…10,20,26,35 Based on these findings, we instituted a protocol that consisted of lowering the acceptable transfusion trigger level of hemoglobin, initiating EPO/iron treatment prior to surgery to increase the preoperative hemoglobin level, and utilizing an intraoperative blood recycling device such as Cell Saver or OrthoPAT (Haemonetics Corporation) to minimize the overall rate of allogenic blood transfusion at our institution.…”

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confidence: 99%

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

Vega¹,

Lyon²,

Kierce³

et al. 2014

PED

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Object Children with craniosynostosis may require cranial vault remodeling to prevent or relieve elevated intracranial pressure and to correct the underlying craniofacial abnormalities. The procedure is typically associated with significant blood loss and high transfusion rates. The risks associated with transfusions are well documented and include transmission of infectious agents, bacterial contamination, acute hemolytic reactions, transfusion-related lung injury, and transfusion-related immune modulation. This study presents the Children's Hospital of Richmond (CHoR) protocol, which was developed to reduce the rate of blood transfusion in infants undergoing primary craniosynostosis repair. Methods A retrospective chart review of pediatric patients treated between January 2003 and Febuary 2012 was performed. The CHoR protocol was instituted in November 2008, with the following 3 components; 1) the use of preoperative erythropoietin and iron therapy, 2) the use of an intraoperative blood recycling device, and 3) acceptance of a lower level of hemoglobin as a trigger for transfusion (< 7 g/dl). Patients who underwent surgery prior to the protocol implementation served as controls. Results A total of 60 children were included in the study, 32 of whom were treated with the CHoR protocol. The control (C) and protocol (P) groups were comparable with respect to patient age (7 vs 8.4 months, p = 0.145). Recombinant erythropoietin effectively raised the mean preoperative hemoglobin level in the P group (12 vs 9.7 g/dl, p < 0.001). Although adoption of more aggressive surgical vault remodeling in 2008 resulted in a higher estimated blood loss (212 vs 114.5 ml, p = 0.004) and length of surgery (4 vs 2.8 hours, p < 0.001), transfusion was performed in significantly fewer cases in the P group (56% vs 96%, p < 0.001). The mean length of stay in the hospital was shorter for the P group (2.6 vs 3.4 days, p < 0.001). Conclusions A protocol that includes preoperative administration of recombinant erythropoietin, intraoperative autologous blood recycling, and accepting a lower transfusion trigger significantly decreased transfusion utilization (p < 0.001). A decreased length of stay (p < 0.001) was seen, although the authors did not investigate whether composite transfusion complication reductions led to better outcomes.

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“…Although the feasibility of this technique is not clearly established, Orliaguet and colleagues compared CATS intraoperative blood salvaging with the postoperative use of the CBCII Consta Vac system in a retrospective nonrandomized study [43]. They found the postoperative blood salvaging system was equally effective as the perioperative use of the CATS system for reducing homologous blood transfusion during craniosynostosis repair in infants weighing less than 10 kg.…”

Section: Perioperative Blood Salvagementioning

confidence: 99%

Perioperative Management of Pediatric Patients with Craniosynostosis

Koh

Gries

2007

Anesthesiology Clinics

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Comparison of perioperative blood salvage and postoperative reinfusion of drained blood during surgical correction of craniosynostosis in infants

Abstract: Our results suggest that the postoperative use of the CBCII ConstaVac(R) system is as efficient as the perioperative use of the CATS(R) system for reducing homologous blood transfusion during repair of craniosynostosis in infants weighing <10 kg.

Cited by 32 publications

References 32 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

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

Perioperative Management of Pediatric Patients with Craniosynostosis

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