TRANSFUSION NEED IN ORTHOGNATHIC surgery- A REVIEW
Review Articles
Table 9. Transfusion rates for bimaxillary orthognathic surgery without additional or complex procedures( numbers): summary. Bimaxillary surgery without additional or complex procedures
Predonation policy No predonation policy n ° patients
969 1264 2233
Autologous( n)= patients 324 0 324
Homologous( n)= patients
Total number of patients transfused( n)
* Concerning the 18 patients in the predonation policy group, we found the following:- Rummasak et al.( 2011) 42 had 5 patients with homologous transfusion; it is not stated if this was supplementary to the autologous blood donation.- Hegtvedt et al.( 1987) 13 had 8 patients in this group with homologous transfusion without preceding autologous transfusion.- Rohling et al.( 1999) 41 used both autologous blood and acute normovolemic hemodilution, and 2 patients had additional homologous transfusion. This is considered an overlap in the table of 2 patients.- Kessler et al.( 2006) 39 had one autologous donor receiving additional homologous blood.- Böttger( 2007) 4 referred to homologous blood transfusion for those who did not participate in the predonation program.
Study |
n / N |
%( 95 % CI) |
Predonation policy Hegtvedt et al.( 1987) |
41 / 96 |
42.7( 32.7; 53.2) |
Moenning et al.( 1995) |
1 / 33 |
3.0( 0.1; 15.8) |
Guyuron et al.( 1996) |
12 / 20 |
60.0( 36.1; 80.9) |
Puelacher et al.( 1998) |
37 / 45 |
82.2( 67.9; 92.0) |
Lenzen et al.( 1999) |
69 / 69 |
100.0( 94.8; 100.0) |
Rohlin et al.( 1999) |
23 / 127 |
18.1( 11.8; 25.9) |
Felfernig-Boehm et al.( 2001) |
3 / 30 |
10.0( 2.1; 26.5) |
Gong et al.( 2002) |
16 / 83 |
19.3( 11.4; 29.4) |
Nkeke et al.( 2005) |
3 / 56 |
5.4( 1.1; 14.9) |
Kessler et al.( 2006) |
7 / 65 |
10.8( 4.4; 20.9) |
Botger S.( 2007) |
66 / 82 |
80.5( 70.3; 88.4) |
Lassacher( 2009) |
1 / 55 |
1.8( 0.0; 9.7) |
Rummasak et al.( 2011) |
63 / 208 |
30.3( 24.1; 37.0) |
Total |
342 / 969 |
39.0( 22.8; 57.4) |
No predonation policy Golia et al.( 1985) |
0 / 4 |
0.0( 0.0; 60.2) |
Ash and Mercuri( 1985) |
4 / 20 |
20.0( 5.7; 43.7) |
Fromme et al.( 1986) |
35 / 56 |
62.5( 48.5; 75.1) |
Lessard et al.( 1989) |
15 / 52 |
28.8( 17.1; 43.1) |
Samman et al.( 1996) |
78 / 291 |
26.8( 21.8; 32.3) |
Yu et al.( 2000) |
1 / 21 |
4.8( 0.1; 23.8) |
Umstadt et al.( 2000) |
2 / 66 |
3.0( 0.4; 10.5) |
Carry et al.( 2001) |
0 / 24 |
0.0( 0.0; 14.2) |
Stewart et al.( 2001) |
9 / 27 |
33.3( 16.5; 54.0) |
Panula et al.( 2001) |
31 / 91 |
34.1( 24.5; 44.7) |
Dhariwal et al.( 2004) |
9 / 115 |
7.8( 3.6; 14.3) |
Ueki et al.( 2005) |
0 / 29 |
0.0( 0.0; 11.9) |
Landes et al.( 2008) |
2 / 70 |
2.9( 0.3; 9.9) |
Kretschmer et al.( 2008) |
0 / 91 |
0.0( 0.0; 4.0) |
Varol et al.( 2009) |
0 / 45 |
0.0( 0.0; 7.9) |
Fenner et al.( 2009) |
0 / 105 |
0.0( 0.0; 3.5) |
Garg( 2011) |
0 / 125 |
0.0( 0.0; 2.9) |
Karimi et al.( 2012) |
1 / 32 |
3.1( 0.1; 16.2) |
|
Total
Overall total
|
187 / 1264 12.5( 5.6; 24.0)
529 / 2233 23.8( 14.8; 35.1)
|
% transfusion |
18 187 205
342 * 187 529
Figure 3. Error-bar chart, bimaxillary surgery without additional surgery; dots representing % of transfusion, blue dots represent study total, red dots represent group total, green dot represents overall total, horizontal lines representing 95 % confidence interval.
stable. These series heavily influence the dataset and reflect a shift in transfusion policy. This policy is not new and was already advocated in Germany in 2003( Habler et al., 2007). 51 When combining the effects of time and predonation policy, we find an opposite evolution in transfusion policy. The predonation centers have not changed transfusion policy and account for the majority of blood transfusions in this series. Predonation is the most prominent risk factor in bimaxillary surgery to expose a patient to blood transfusion, even if it is autologous blood( Table 12, Table 13). A similar attitude of liberal transfusion when autologous blood is available has been found in other surgical disciplines with about the same ratio.( Forgie et al., 1998) 52
When further broken down by author, Table 14 presents the numbers of bimaxillary surgeries( aggregated figures) with the corresponding number and percentage of autotransfusions, clearly illustrating the wide variability in transfusion policy towards autologous blood donation. The role of hypotension as critical risk factor for transfusion has been investigated in this series, but this must be regarded as‘ very low level of evidence’ because few studies are fully comparable in their mean arterial pressure and in the duration of the mean arterial pressure, or even in the way the mean arterial pressure was measured. When aggregating the data to normotension, controlled hypotensionnot further specified, controlled hypotension mild, controlled hypotension moderate, and controlled
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