STOMATOLOGY EDU JOURNAL 2017, Volume 4, Issue 3 SEJ_3-2017_Online - Page 38

TRANSFUSION NEED IN ORTHOGNATHIC surgery - A REVIEW Table 4. Mean blood loss for Le Fort I single-jaw osteotomies without concomitant surgery, sorted according to mean blood loss reported per author. Le Fort I single-jaw osteotomy without segmentation or additional procedures Mean Number Predonation blood of policy Author loss patients (1=yes, 0=no) Dolman et al. (2000) 120 11 0 de Lange et al. (2008) 144 15 0 Moenning et al. (1995) 231 16 0 Yu et al. (2000) 266 8 0 Dolman et al. (2000) 270 12 0 Ash and Mercuri (1985) 327 20 0 de Lange et al. (2008) 346 15 0 Yu et al. (2000) 348 10 0 Puelacher et al. (1998) 410 23 1 Dickerson et al. (1993) 421 12 0 Golia et al. (1985) 480 5 0 Zellin et al. (2004) 530 16 0 Lenzen et al. (1999) 670 26 1 Panula et al. (2001) 697 65 0 Böttger (2000) 850 28 1 Study n/N %(95% CI) Predonation policy Hegtvedt et al. (1987) 1/25 4.0 (0.1;20.4) Moenning et al. (1995) 0/16 0.0 (0.0;20.6) Puelacher et al. (1998) 13/23 56.5 (34.5;76.8) Lenzen et al. (1999) 4/26 15.4 (4.4;34.9) Botger S. (2007) 17/28 60.7 (40.6;78.5) Total 35/118 26.3 (8.5;54.0) No predonation policy Golia et al. (1985) 0/5 0.0 (0.0;52.2) Ash and Mercuri (1985) 1/20 5.0 (0.1;24.9) Flood et al. (1990) 3/26 11.5 (2.4;30.2) Dickerson et al. (1993) 0/12 0.0 (0.0;26.5) Yu et al. (2000) 0/18 0.0 (0.0;18.5) Dolman et al. (2000) 1/23 4.3 (0.1;21.9) Umstadt et al. (2000) 2/129 1.6 (0.2;5.5) Carry et al. (2001) 0/16 0.0 (0.0;20.6) Panula et al. (2001) 10/65 15.4 (7.6;26.5) Zelllin et al. (2004) 2/16 12.5 (1.6;38.3) Landes et al. (2008) 0/4 0.0 (0.0;60.2) de Lange et al. (2008) 0/30 0.0 (0.0;11.6) Garg (2011) 0/44 0.0 (0.0;8.0) Total 19/408 4.5 (1.8;9.8) Overall total 54/526 10.7 (4.6;21.0) and Mercuri, 1985; 7 Flood et al., 1990 11 Hegtvedt et al., 1987; 13 Moenning et al., 1995; 17 Samman et al., 1996; 35 Yu et al., 2000; 24 Zellin et al., 2004; 33 and Landes et al., 2008. 14 The figures in parentheses give the number of patients concerned. In the paper by Flood et al. (1990), 11 38 Le Fort I procedures were completed with an additional genioplasty. Preoperative hemoglobin level dropped from 14.2 g/dL to 12.4 g/dL. None of these patients would nowadays qualify for blood transfusion. These data can be qualified as outliers. The paper by Schaberg et al. (1976) 34 does not give a figure of transfusion, 14 patients. The resulting 159 patients are listed in Table 5. In these 159 patients, 3 autologous transfusions were reported and 8 homologous blood transfusions for a total of 11 transfusions on 159 patients, or 6.9% in a numerical analysis. The estimated transfusion rates according to the logistic regression model are 7.6 % in the no-predonation policy group and 5.6 % in the predonation policy group (Table 6). This compares favourably with single-jaw Le Fort I procedures of less complex nature, even though the mean blood loss of complex Le Fort I surgery is significantly different from single piece Le Fort I surgery. Because of the lack of reliable data, no duration of operation can be compared between single Le Fort I procedures with or without additional complex procedures. A number of comments need to be made concerning the two studies with a predonation policy (Hegtvedt et al., 1987; 13 Moenning et al., 1995 17 ). Hegtvedt et al. (1987) 13 stated that no patient who predonated blood received any homologous transfusion. A conservative approach towards transfusion was % transfusion Figure 1. Error-bar chart, 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, Le Fort I single-jaw osteotomy without additional complex procedures: transfusion policy. 188 Stoma Edu J. 2017;4(3): 184-199 http://www.stomaeduj.com