Introduction: Operative blood loss in craniosynostosis surgery in children can range from minimal to extensive, depending on the procedure; transfusion events are not uncommon. This study aimed to examine factors related to the likelihood of blood transfusion in children aged 0-3 months undergoing surgery for craniosynostosis in the modern era.
Methods: The Kids Inpatient Database (KID) in the year 2009 was queried for children aged 0-3 months with an ICD-9 diagnosis code for craniosynostosis and a procedure code for craniosynostosis surgery. The age range was chosen to enrich the cohort in endoscopic suturectomy cases over open cranial vault remodeling, however data on the specific surgical technique utilized in each case is not available in KID. Multivariate logistic analyses were used to identify covariates associated with increased incidence of blood transfusion.
Results: Results: An estimated total of 411 hospital admissions for craniosynostosis surgery were identified in 2009. The mean age was 2.3 months, and the mean length of stay (LOS) was 4 days. Within the cohort, 12.8% of the subjects had congenital anomalies and 4.5% had abnormal coagulation profiles. Overall, 32.3% of the patients underwent transfusion. In a multivariate model controlling for demographic, hospital, and clinical factors, presence of a procedural hemorrhagic event (OR 4.6, p<0.001), or a co-morbid congenital anomaly (OR 2.9, p=0.003) were associated with increased incidence of transfusion. Hospital location in the Southern United States (OR 0.32, p=0.03) was associated with a decreased incidence of transfusion. Age, sex, hospital type, hospital volume, presence of coagulation deficits and hospital LOS were not associated with transfusion incidence.
Conclusions: Procedural hemorrhage, presence of a congenital anomaly, and hospital location were significantly associated with incidence of transfusion in patients aged <3 months undergoing surgical management of craniosynostosis.
Patient Care: By offering groundwork for future prospective studies on minimizing blood loss in craniosynostosis surgery.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Understand factors associated and not associated with blood transfusion in young children undergoing surgical management of craniosynostosis.
References: Berry-Candelario J, Ridgway EB, Grondin RT, Rogers GF, Proctor MR. Endoscope-assisted strip craniectomy and postoperative helmet therapy for treatment ofcraniosynostosis. Neurosurg Focus. 2011 Aug;31(2):E5.
Shah MN, Kane AA, Petersen JD, Woo AS, Naidoo SD, Smyth MD. Endoscopically assisted versus open repair of sagittal craniosynostosis: the St. Louis Children's Hospital experience. J Neurosurg Pediatr. 2011 Aug;8(2):165-70
Jimenez DF, Barone CM. Early treatment of coronal synostosis with endoscopy-assisted craniectomy and postoperative cranial orthosis therapy: 16-year experience. J Neurosurg Pediatr. 2013 Sep;12(3):207-19
McCarthy JG, Warren SM, Bernstein J, Burnett W, Cunningham ML, Edmond JC, Figueroa AA, Kapp-Simon KA, Labow BI, Peterson-Falzone SJ, Proctor MR, Rubin MS, Sze RW, Yemen TA; Craniosynostosis Working Group. Parameters of care for craniosynostosis. Cleft Palate Craniofac J. 2012 Jan;49 Suppl:1S-24S.