Impact of Intraoperative Transfusion Volume on Length of Stay in Synostosis Repair

Abstract

Objective

To examine the impact of intraoperative packed red blood cell (pRBC) transfusion status and volume on the length of stay (LOS) for patients undergoing open or endoscopic craniosynostosis repair.

Design

Retrospective consecutive case series for craniosynostosis repair.

Setting

NewYork-Presbyterian/Weill Cornell Medicine (WCM) 2016 to 2024.

Patients/Participants

A total of 232 patients undergoing craniosynostosis repair were included. Cases without vault remodeling or those considered non-standard/complex were excluded.

Intervention

Endoscopic or open craniosynostosis repair.

Main Outcome Measures

LOS, complications.

Results

Of 232 cases, 109 (47.0%) were treated with open cranial vault remodeling, and 123 (53.0%) underwent endoscopic suturectomy. Open cases had significantly higher blood loss, pRBC transfusion volume, TXA transfusion status and volume, and longer LOS (4.1 ± 4.0 days vs 1.2 ± 0.7 days). The transfusion rate was 58.7% in open cases versus 4.1% in endoscopic cases, with mean volumes of 27.9 ± 19.5 cc/kg and 17.3 ± 11.5 cc/kg, respectively. While transfusion status did not affect LOS in either cohort, multivariate linear regression, accounting for variables such as age, gender, weight, surgical approach, and case duration, found that transfusion volume independently predicted LOS. Patients with multiple sutural fusion generally had longer LOS than patients with singular sutural fusion.

Conclusions

Minimizing transfusion volumes could reduce LOS, emphasizing the need for improved surgical planning and anesthetic strategies to reduce transfusion burden. This study's retrospective, single-center design limits its generalizability, necessitating prospective trials to standardize transfusion criteria and assess the impact of preoperative hemoglobin and hematocrit's role in outcomes.