104. Predictors of Blood Transfusion for Endoscopic Assisted Craniosynostosis Surgery

Authors: Eric M. Thompson, MD, FAANS

Blood loss is a main cause of morbidity after craniofacial procedures. The purpose of this study is to identify predictors for transfusion of blood products in the endoscopic assisted strip craniectomy (ESC) population.Methods: Data was prospectively collected from a single-center multi-surgeon cohort of 78 consecutive patients who underwent ESC for craniosynostosis between July 2013 and December 2020.
Of the 78 patients, 26 patients (33%) were transfused. Only 6 (8%) cases had transfusions over the 25 ml/kg pRBCs National Surgical Quality Improvement Program-Pediatric (NSQIP-P) threshold. Patients’ weight in the transfusion cohort were significantly lower than those who did not receive a transfusion (5.6 ± 1.1 vs. 6.5 ± 1.1 kg, p=0.0008). Amount of colloid administered during surgery was significantly greater in the transfusion group (88.7 ± 85.8 vs. 51.5 ± 44.4 mL, respectively, p=0.0136). Eleven percent of patients admitted to step-down received a transfusion while 39% of patients admitted to the pediatric intensive care unit received a transfusion (p=0.042). Upon multivariate analysis, higher patient weight (OR 0.305 [0.134,0.693], p=0.005) was protective against a transfusion while colloid volume (OR 1.018 [1.003,1.033], p=0.019) predicted the need for a transfusion.
Our results demonstrate that endoscopic craniosynostosis cases carry a moderate risk of transfusion.