Predictors of Red Blood Cell Transfusion in Bimaxillary Orthognathic Surgery: A Retrospective Study

Abstract

Background: Orthognathic surgery requires red blood cell (RBC) transfusions more frequently than other oral and maxillofacial surgeries. The purpose of this study was to identify reliable predictors for RBC transfusion during bimaxillary orthognathic surgery (BOS). Methods: This retrospective study reviewed 1,616 electronic medical records of patients who underwent BOS during a 5-year period at Seoul National University Dental Hospital. The perioperative variable data were collected from electronic medical records and analyzed by dividing patients into the two groups (non-transfusion and transfusion group). Results: Of the 1,616 patients, 1,311 patients were excluded. The remaining 305 patients were divided into non-transfusion (NTF, n = 256) and transfusion (TF, n = 49) groups. Univariate logistic regression analysis revealed that age, body mass index, the presence of several adjunctive surgeries (including genioplasty, extraction, and mandibular angle reduction), preoperative hemoglobin (Hb) and prothrombin time, surgical time, amount of fluid infusion and blood loss, and mean pulse rate during surgery were significant factors predicting RBC transfusion. Multivariate logistic regression analysis revealed that preoperative Hb and blood loss amount during surgery were significantly related to RBC transfusion in BOS patients. Conclusion: Since blood loss amounts could not be measured preoperatively, we found that the independent predictor associated with RBC transfusion during BOS was a low preoperative Hb level.

Development and Validation of a Nomogram to Predict the Risk of Blood Transfusion in Orthognathic Patients

“…[28][29][30][31] For example, Rhee et al found that preoperative HGB level was an independent predictor associated with RBC transfusion during bimaxillary surgery. 32 Preoperative HGB was 12.9 g/dL in the transfusion group versus 14.7 g/dL in the non-transfusion group. Some authors 33 reported that the probability of blood transfusion will increase 5 times in the patients with a preoperative HGB < 120 g/L.…”

“…Rhee et al reported an average blood loss of 532.6 mL in the non-transfusion and 775.9 mL in the transfusion group. 32 They showed that estimated blood loss was an independent predictor of blood transfusion. Stehrer et al found that the amount of perioperative blood loss was 421.5 ml and bimaxillary group had more blood loss of 494.1 ml.…”

“…[39][40][41][42] For example, Rhee et al 2021 found that patients in the transfusion group had a significantly younger age (21.8 versus 23.4 years) and lighter weight (56.8 versus 65.2 kg) than the non-transfusion group. 32 This difference may be caused by the heterogeneous population in different studies.…”