Assessment of transfusion practices during craniosynostosis repairs

Objective: To evaluate the changes in transfusion practices during craniosy nostosis surgery in children, with consideration of the transfusion-associa ted risks. Study design: Retrospective study. Patients: The study included 64 consecutive craniosynostosis repairs by the same neurosurgical and anaesthetic team, over a period of 17 years. Methods: The children were allocated into two groups. In group I (1980-1991 ), blood loss was compensated precisely from scalp incision on. In group II (1992-1996), transfusion was only started when blood loss crossed a calcul ated limit considered as acceptable. The mean criterion of judgment was the quantity of transfused blood in comparison with the theoretical blood volu me. Mean preoperative and postoperative haemoglobin concentrations, estimat ed blood losses, volume of replaced blood and number of transfused patients were compared between the two groups with a two tailed Student's t test. Results: The rate of non transfused children increased from 6% before 1991 to 39% after 1992%; conservely the rate of postoperative transfusions incre ased from 3 to 39%. Conclusion. The risks of blood transfusion favoured the development of new of more restrictive transfusion practices, even in haemorragic surgery. To limit blood transfusion in craniosynostosis surgery, a harmonious cooperati on between surgeons and anaesthetists is essential and blood replacement mu st be based on a definite determination of the acceptable blood losses. (C) 2000 Editions scientifiques et medicales Elsevier SAS.