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.
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