Table 5. Transfusion rate for Le Fort I single jaw surgery with additional procedures.
Predonation policy Study n/N % No predonation policy Ash and Mercuri (1985) 2/6 33.3 (4.3;77.7)
Samman et al. (1996) 6/69 8.7 (3.3;18.0)
Yu et al. (2000) 0/12 0 (0.0;26.5)
Zelllin et al. (2004) 0/14 0 (0.0;23.2)
Landes et al. (2008) 0/4 0 (0.0;60.2)
8/105 7.6 (3.9;14.5)
Hegtvedt et al. (1987) 3/34 8.8 (1.9;23.7)
Moenning et al. (1995) 0/20 0 (0.0;16.8)
Total 3/54 5.6 (1.8;15.9)
11/159 6.9 (3.9;12.1)
Total
Predonation policy
Overall total
95% CI
The overall transfusion rates are estimated using a logistic regression model. Where n is the number of patient and N is the
total number of patient.
in the no-predonation policy group.
Complex Le Fort I surgery should not be
underestimated. It usually is more difficult to
advance a maxilla to an extent that a bone graft is
needed. Certainly, complex isolated Le Fort I surgery
with multiple segments and additional bone graft–
harvesting procedures may be more challenging
and time consuming than straightforward bimaxillary
procedures where the magnitude of movements is
smaller, often to overcome the difficulty of a large
single-jaw movement, which in addition is less stable.
In this series of 211 complex single Le Fort I
osteotomies, 181 were performed before the year
2000 and 30 after. None of these 30 required a
blood transfusion.
3.1.4. Bimaxillary surgery without additional
complex procedures
The aggregation of data allowed inclusion in this
category of the normal Le Fort I one piece with
BSSO (advancement, rotation, or set-back). If an
author stated that a two-piece or a straightforward
genioplasty was considered in this group because
of the ease of the routine not adding much to
the duration of the surgery, this was accepted
in this category. If any additional procedure was
not accounted for by the author when discussing
‘bimaxillary osteotomies’, these were accommodated
in this category.
The group with predonation consisted of
the following papers (numbers of patients in
favoured because blood losses over 1000 mL and
hematocrits of 26% and 29% were not transfused
because of a stable clinical condition. Moenning et
al. (1995) 14 used a strict transfusion trigger, even for
autologous blood, and stated that the hemoglobin
level must be below 7 g/dL and the hematocrit
below 21% before transfusions were indicated for
a symptomatic patient requiring autologous blood.
It is obvious that predonation does not preclude
the use of strict transfusion criteria. If these are met,
no clinically significant difference in transfusion
rate is observed between a predonation and no-
predonation policy.
A statistical analysis of this group was done in SAS;
95% exact confidence intervals were calculated for
the individual studies. The overall transfusion rates
and corresponding 95% confidence intervals were
estimated using a logistic regression model. No
significant difference between predonation and
no-predonation policy could be shown. (p=0.6288)
The intra-study correlation was not estimable using
a beta-binomial model and hence set to zero. For
this reason no probit-model was used and a logistic
regression model was chosen (Fig. 2).
The transfusion rate for Le Fort I single-jaw
osteotomy without additional complex procedures
is 4.5% according to the statistical model in the no-
predonation policy group, whereas the addition
of complex procedures to a Le Fort I single-jaw
osteotomy increases the transfusion rate up to 7.6%
TRANSFUSION NEED IN ORTHOGNATHIC surgery - A REVIEW
Table 6. Transfusion rate in Le Fort I single jaw osteotomy with additional surgery: predonation policy versus no-predonation policy.
Le Fort I single-jaw surgery with additional complex procedures
n° patients
n° patients Autologous/
transfused homologous
%
Predonation policy 54 3 Autologous 5.6%
No predonation policy 105 8 Homologous 7,6%
159 3
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