Predictors of Transfusion Outcomes for Patients Undergoing Surgical Correction of Craniosynostosis: A Multicenter Retrospective Analysis

ObjectiveIntraoperative transfusion during corrective surgery for craniosynostosis is common. We sought to evaluate determinants of intraoperative transfusion for patients with nonsyndromic, single-suture craniosynostosis undergoing primary repair.DesignWe queried the multicenter Pediatric Craniofacial Surgery Perioperative Registry for patients undergoing correction of craniosynostosis between June 2012 and January 2023. Nonsyndromic patients who underwent primary repair of single suture craniosynostosis at <12 months of age were included. Univariate and multivariate logistic regressions were performed.Main Outcome MeasureIntraoperative transfusion requirement.ResultsA total of 3994 patients met inclusion criteria, and 2261 (56.6%) received an intraoperative blood transfusion. Those who received an intraoperative transfusion had longer surgery duration (93.8 ± 1.5 vs 180.1 ± 1.9 min, <i>P</i> < .001), increased weight (6.8 ± 0.04 vs 7.8 ± 0.03 kg, <i>P</i> < .001), and were older (4.1 ± 0.1 vs 6.6 ± 0.1 months, <i>P</i> < .001) and more likely female (odds ratio [OR] 1.18, 95% confidence interval [CI]:1.03-1.35, <i>P</i> = .018). For 144 (3.6%) patients who received preoperative iron supplementation, the incidence of intraoperative transfusion was decreased (OR 0.39; 95%CI: 0.27-0.57, <i>P</i> < .001). In multivariate analysis, factors independently associated with higher odds of intraoperative transfusion included longer surgery duration (<i>P</i> < .001), increasing age (<i>P</i> = .017), lower weight (<i>P</i> = .011), higher American Society of Anesthesiologists class (<i>P</i> < .001), procedure (<i>P</i> < .001) (especially nonendoscopic), lack of preoperative iron supplementation (<i>P</i> < .001), and lower preoperative hemoglobin (<i>P</i> = .038).ConclusionsVarious factors influence the incidence of transfusion in patients undergoing primary surgical correction of single suture craniosynostosis. Timing of surgery and optimization of preoperative hemoglobin with iron supplementation represent possible modifiable risk factors that warrant additional, prospective study.