TRANSFUSION NEED IN ORTHOGNATHIC surgery - A REVIEW
190
Study n/N
%(95% CI)
Predonation policy
Hegtvedt et al. (1987) 3/34 8.8 (1.9;23.7)
Moenning et al. (1995) 0/20 0.0 (0.0;16.8)
Total 3/54 5.6 (1.8;15.9)
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 (0.0;26.5)
Zellin et al. (2004) 0/14 0.0 (0.0;23.2)
Landes et al. (2008) 0/4 0.0 (0.0;60.2)
No predonation policy
Total 8/105
7.6 (3.9;14.5)
Overall total
11/159
6.9 (3.9;12.1)
% transfusion
Figure 2. Error-bar chart, Le Fort I single jaw osteotomy with 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.
parentheses): Böttger, 2007 4 (82 patients); Felfernig-
Boehm et al., 2001 36 (30 patients); Gong et al., 2002 37
(83 patients); Guyuron et al., 1996 38 (20 patients);
Hegtvedt et al., 1987 13 (96 patients); Kessler et al.,
2006 39 (65 patients); Lassacher, 2008 5 (55 patients);
Lenzen et al., 1999 30 (69 patients); Moenning et al.,
1995 17 (33 patients); Nkeke et al., 2005 40 (56 patients);
Puelacher et al., 1998 19 (45 patients); Rohling et al.,
1999 41 (127 patients); and Rummasak et al., 2011 42
(208 patients), for a total of 969 patients. (Table 7)
The group without predonation policy consisted
of 1331 patients: Ash and Mercuri, 1985 7 (20
patients); Carry et al., 2001 9 (24 patients); Dhariwal
et al., 2004 43 (115 patients); Fenner et al., 2009 44 (105
patients); Flood et al., 1990 11 (67 patients); Fromme
et al., 1986 45 (56 patients); Garg et al., 2011 12 (125
patients); Golia et al., 1985 28 (4 patients); Karimi et
al., 2012 46 (32 pati ents); Kretschmer et al., 2008 47 (91
patients); Landes et al., 2008 14 (70 patients); Lessard
et al., 1989 48 (52 patients); Panula et al., 2001 18 (91
patients); Samman et al., 1996 35 (291 patients);
Stewart et al., 2001 49 (27 patients); Ueki et al., 2005 21
(29 patients); Umstadt et al., 2000 22 (66 patients);
Varol et al., 2009 50 (45 patients); and Yu et al., 2000 24
(21 patients). Including Flood et al. (1990), 11 we get
1331 patients. When excluding Flood et al. (1990) 11
as an outlier, 1264 patients remain in the group
without predonation. (Table 8)
The overall total consisted of 1264 + 969=2233
patients. This was defined as the study group.
A statistical analysis was done in the SAS program
and 95% exact confidence intervals were calculated
for the individual studies. The overall transfusion rates
and corresponding 95% confidence intervals were
estimated using a probit-normal model. A significant
difference between the predonation and the no-
predonation policy could be shown (p=0.0099).
The intra-study correlation in the no-predonation
policy group was 0.32 (p=0.0004). The intra-study
correlation in the predonation policy group was 0.42
(p=<.0001). A significant year effect could be shown
in the no-predonation policy group (p=0.0154).
No significant year effect could be shown in the
predonation policy group (p=0.4574). No significant
difference in year effect could be shown between the
predonation and the no-predonation policy group
(p=0.4334). (Table 5; Table 6; Fig. 3)
In total, there were 3 overlapping patients who
received both autologous and homologous blood.
For the statistical analysis we viewed these as
separate patients, resulting in 342 patients in the
statistical analysis. (Table 9)
When these figures are expressed as % , we find a
discrepancy between the transfusion rate in centres
with or without a predonation policy of autologous
blood (Table 10).
These figures need to be put into perspective.
Obviously, there is a discrepancy between the
transfusion rate in centres with (39%) or without (12,5
%) a predonation policy of autologous blood (Table
7; Table 8; Fig. 3).
This discrepancy between these centers is even
sharper when the evolution in time is entered as a
variable (Table 11).
Looking at the data for centers where only
homologous transfusion is given, a sharp decline
in the number of transfusions is seen in the papers
after 2006. A representative paper that reflects
the contemporary attitude is found in Fenner et al.
(2009). 44 In 105 consecutive bimaxillary surgeries,
none of their patients received allogeneic blood,
and no autologous blood was donated presurgery.
They allowed a reduction in hemoglobin to 60 g/L as
long as the ASA I patient remained hemodynamically
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