A Quality Improvement Project to Limit Perioperative Transfusion During Craniofacial Surgery in Infants and Children.

Abstract

Introduction: Open surgery for craniosynostosis in infants and children is frequently associated with significant intraoperative blood loss and the need for allogeneic transfusion therapy. A lack of consensus at our institution led to inconsistent transfusion therapy during open cranial vault remodeling. We sought to address this through a multidisciplinary quality improvement approach to decrease variability in transfusion practices.

Methods: A streamlined intraoperative transfusion algorithm, from the moment the patient was evaluated in the preoperative holding area on the day of surgery through their departure from the postanesthesia care unit, was implemented during quarter 1 of 2021. We aimed to decrease the percentage of intraoperative transfusions administered at hemoglobin (Hgb) levels greater than 7.5 g/dL in stable patients without massive bleeding undergoing open craniosynostosis surgery from 40% in January 2021 to 0% by December 2023.

Results: From January 2018 to December 2023, 118 pediatric patients underwent open cranial vault remodeling for craniosynostosis. Before the implementation of the protocol in quarter 1 of 2021, open cranial vault reconstruction (CVR) intraoperative transfusion rates in cases where the threshold was not met (Hgb >7.5 g/dL) were 32%. After protocol implementation, open CVR intraoperative transfusion rates that did not meet the threshold averaged 5%.

Conclusions: In this quality improvement project, we decreased transfusion rates for patients with Hgb greater than 7.5 g/dL from 32% to 5% during 3 years. We have successfully developed and implemented an intraoperative blood transfusion algorithm that is generalizable and requires minimal human and material resources.