STOMATOLOGY EDU JOURNAL 2017, Volume 4, Issue 3 SEJ_3-2017_Online - Page 40

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