TRANSFUSION NEED IN ORTHOGNATHIC surgery - A REVIEW

( 2009 ) 53 and Rummasak et al . ( 2011 ) 42 were not retained because they did not give a transfusion rate . The following papers were included in the no-predonation policy : Ash and Mercuri , 1985 7 ( 8 patients ); Choi et al ., 2009 54 ( 61 patients ); Kretschmer et al ., 2008 47 ( 36 patients ); Landes et al ., 2008 14 ( 13 patients ); and Stewart et al ., 2001 49 ( 2 patients ). Three papers with a predonation policy were retained in this category : Blau et al ., 1992 55 ( 30 patients ); Moenning et al ., 1995 17 ( 155 patients ); and Posnick et al ., 2010 56 ( 34 patients ). Posnick et al . ( 2010 ) 56 did not indicate a criterion of transfusion but believed a level below 7 g / dL ( Hc = 21 %) was a definite indication for transfusion , with room for evaluation of the clinical need and transfusion before that level is reached if necessary . Blau et al . ( 1992 ) 55 stated that they did not use uniform criteria for postoperative transfusion ; indeed , many patients received transfusion postoperatively before documentation of the postoperative hemoglobin concentration . Pooling of the other data showed adherence to equal and strict transfusion criteria when considering autologous or homologous blood transfusion . The ‘ arithmetic ’ overall requirement of blood transfusion is 12.4 %, which signifies a figure almost double as that of a single-jaw procedure ( Table 17 , Table 3 ). However , when these figures are entered into a statistical model , the % are not the aritmethic % ( 42 / 339 = 12,4 ) but estimated % based on the probitnormal model containing all groups (( 42 / 339 ; 20,6 %; ( 7.1 ; 43.2 ) 95 % CI )). Statistics were done in the SAS program and 95 % exact confidence intervals were calculated for the individual studies . In Table 18 the overall transfusion rates and corresponding 95 % confidence intervals were estimated using a probit-normal model . No significant difference between the predonation and the no-predonation policy could be shown ( p = 0.5047 ). The intra-study correlation was found to be significant . In the no-predonation policy the intrastudy correlation was 0.29 ( p = 0.0769 ). The intrastudy correlation in the predonation policy group was 0.26 ( p = 0.0960 ), ( Fig . 4 ). Four patients in the group with the predonation policy ( Table 18 ) received homologous blood : one in the series of Posnick et al . ( 2010 ) 56 who did not predonate , and three in the series of Moenning et al . ( 1995 ) 17 were patients that received both autologous and additional homologous blood . Total : 22 patients in the predonation policy group received a blood transfusion . Moenning ’ s patients who received both autologous and homologous blood were classified as having received autologous blood only . One would assume that the clinical message is clear . As long as bimaxillary surgery is straightforward , the need for blood transfusion remains well defined . Once additional procedures are executed , the risk for blood transfusion increases significantly . Table 19 summarizes the findings of the transfusion rates reported in the reviewed articles . In the predonation policy centers obviously the transfusion rate reflects a policy rather than a transfusion need . In the other centers without predonation policy the increasing complexity of the surgical orthognathic procedure goes along with an increased transfusion rate . The statistical model used to study bimaxillary surgery with a predonation policy yielded no statistically significant difference between simple and complex procedures ( p = 0.1257 ). The intrastudy correlation in the simple bimaxillary procedure group with predonation was 0.42 ( p = 0.0002 ). The intra-study correlation in the complex bimaxillary procedure group with predonation was 0.26 ( p = 0.1160 ). The statistical model used to study bimaxillary surgery with no-predonation policy yielded no statistically significant difference between simple and complex procedures ( p = 0.2571 ), in spite of the arithmetic

Table 14 . Transfusion policy according to author , in bimaxillary surgery without concomitant procedures .

Stoma Edu J . 2017 ; 4 ( 3 ): 184-199 http :// www . stomaeduj . com