# An Evaluation of the Adequacy of the Liberal Transfusion Strategy in Endoscopy-Assisted Metopic, Coronal, or Sagittal Craniosynostosis Surgeries: A Retrospective Observational Study

## TL;DR

This study assesses whether a liberal blood transfusion strategy is effective in pediatric craniosynostosis surgeries, finding it maintains adequate blood cell mass.

## Contribution

The study evaluates transfusion adequacy using ERCM ratios in endoscopic craniosynostosis surgeries for the first time.

## Key findings

- Liberal transfusion maintained ERCM ratios within the 85–115% range across all craniosynostosis types.
- Significant decreases in hemoglobin and hematocrit levels were observed post-surgery.
- Changes in blood loss and transfusion volumes were noted between 1-hour and 24-hour postoperative measurements.

## Abstract

Background and Objectives: This study aims to evaluate the adequacy of the liberal transfusion strategy applied in patients undergoing endoscopy-assisted Metopic, Coronal, or Sagittal craniosynostosis surgery according to the Pre-Transfusion and Post-Transfusion Estimated Red Blood Cell Mass (ERCM) ratios. Materials and Methods: This retrospective cohort study, conducted at the Pamukkale University Faculty of Medicine (2017–2023), utilized anesthesia, surgical records, and hospital electronic data of patients undergoing endoscopic craniosynostosis surgery. The primary endpoints were the rates of Post-Transfusion 1st-hour ERCM/Pre-Transfusion ERCM (%) and Post-Transfusion 24th-hour ERCM/Pre-Transfusion ERCM (%). The secondary endpoints were determined as Hemoglobin (Hb) and Hematocrit (Hct) values at the 1st and 24th hours after surgery, Calculated Blood Loss (CBL) during surgery (%), total 24 h CBL (%), ERCM (%), and Estimated Blood Loss (EBV) during surgery and total 24 h transfusions, Packed Red Blood Cells (PRBCs) (mL/kg) amounts during surgery, and total 24 h transfusions. Results: A total of 86 pediatric craniosynostosis cases were evaluated and categorized into Metopic (n = 38), Sagittal (n = 33), and Coronal (n = 15) groups, with Post-Transfusion evaluation conducted across these groups. Post-Transfusion 1st-hour ERCM/Pre-Transfusion ERCM ratios were found to have median values of 90.70% in the Metopic group, 91.61% in the Sagittal group, and 93.09% in the Coronal group. Post-Transfusion 24th-hour ERCM/Pre-Transfusion ERCM ratios were found to be median values of 94.05% in the Metopic group, 88.3% in the Sagittal group, and 87.08% in the Coronal group. Conclusions: The liberal transfusion strategy provided adequate transfusion, maintaining ERCM ratios within the 85–115% range across all groups. Significant decreases in Hb and Hct levels were observed from preoperative to postoperative measurements at 1 and 24 h. Changes in CBL, ERCM, EBV, and PRBC volumes were noted between the postoperative 1 h and 24 h measurements across all groups.