TRANSFUSION NEED IN ORTHOGNATHIC surgery - A REVIEW
Review Articles
Table 9 . Transfusion rates for bimaxillary orthognathic surgery without additional or complex procedures ( numbers ): summary . Bimaxillary surgery without additional or complex procedures
Predonation policy No predonation policy n ° patients
969 1264 2233
Autologous ( n )= patients 324 0 324
Homologous ( n )= patients
Total number of patients transfused ( n )
* Concerning the 18 patients in the predonation policy group , we found the following : - Rummasak et al . ( 2011 ) 42 had 5 patients with homologous transfusion ; it is not stated if this was supplementary to the autologous blood donation . - Hegtvedt et al . ( 1987 ) 13 had 8 patients in this group with homologous transfusion without preceding autologous transfusion . - Rohling et al . ( 1999 ) 41 used both autologous blood and acute normovolemic hemodilution , and 2 patients had additional homologous transfusion . This is considered an overlap in the table of 2 patients . - Kessler et al . ( 2006 ) 39 had one autologous donor receiving additional homologous blood . - Böttger ( 2007 ) 4 referred to homologous blood transfusion for those who did not participate in the predonation program .
Study |
n / N |
%( 95 % CI ) |
Predonation policy Hegtvedt et al . ( 1987 ) |
41 / 96 |
42.7 ( 32.7 ; 53.2 ) |
Moenning et al . ( 1995 ) |
1 / 33 |
3.0 ( 0.1 ; 15.8 ) |
Guyuron et al . ( 1996 ) |
12 / 20 |
60.0 ( 36.1 ; 80.9 ) |
Puelacher et al . ( 1998 ) |
37 / 45 |
82.2 ( 67.9 ; 92.0 ) |
Lenzen et al . ( 1999 ) |
69 / 69 |
100.0 ( 94.8 ; 100.0 ) |
Rohlin et al . ( 1999 ) |
23 / 127 |
18.1 ( 11.8 ; 25.9 ) |
Felfernig-Boehm et al . ( 2001 ) |
3 / 30 |
10.0 ( 2.1 ; 26.5 ) |
Gong et al . ( 2002 ) |
16 / 83 |
19.3 ( 11.4 ; 29.4 ) |
Nkeke et al . ( 2005 ) |
3 / 56 |
5.4 ( 1.1 ; 14.9 ) |
Kessler et al . ( 2006 ) |
7 / 65 |
10.8 ( 4.4 ; 20.9 ) |
Botger S . ( 2007 ) |
66 / 82 |
80.5 ( 70.3 ; 88.4 ) |
Lassacher ( 2009 ) |
1 / 55 |
1.8 ( 0.0 ; 9.7 ) |
Rummasak et al . ( 2011 ) |
63 / 208 |
30.3 ( 24.1 ; 37.0 ) |
Total |
342 / 969 |
39.0 ( 22.8 ; 57.4 ) |
No predonation policy Golia et al . ( 1985 ) |
0 / 4 |
0.0 ( 0.0 ; 60.2 ) |
Ash and Mercuri ( 1985 ) |
4 / 20 |
20.0 ( 5.7 ; 43.7 ) |
Fromme et al . ( 1986 ) |
35 / 56 |
62.5 ( 48.5 ; 75.1 ) |
Lessard et al . ( 1989 ) |
15 / 52 |
28.8 ( 17.1 ; 43.1 ) |
Samman et al . ( 1996 ) |
78 / 291 |
26.8 ( 21.8 ; 32.3 ) |
Yu et al . ( 2000 ) |
1 / 21 |
4.8 ( 0.1 ; 23.8 ) |
Umstadt et al . ( 2000 ) |
2 / 66 |
3.0 ( 0.4 ; 10.5 ) |
Carry et al . ( 2001 ) |
0 / 24 |
0.0 ( 0.0 ; 14.2 ) |
Stewart et al . ( 2001 ) |
9 / 27 |
33.3 ( 16.5 ; 54.0 ) |
Panula et al . ( 2001 ) |
31 / 91 |
34.1 ( 24.5 ; 44.7 ) |
Dhariwal et al . ( 2004 ) |
9 / 115 |
7.8 ( 3.6 ; 14.3 ) |
Ueki et al . ( 2005 ) |
0 / 29 |
0.0 ( 0.0 ; 11.9 ) |
Landes et al . ( 2008 ) |
2 / 70 |
2.9 ( 0.3 ; 9.9 ) |
Kretschmer et al . ( 2008 ) |
0 / 91 |
0.0 ( 0.0 ; 4.0 ) |
Varol et al . ( 2009 ) |
0 / 45 |
0.0 ( 0.0 ; 7.9 ) |
Fenner et al . ( 2009 ) |
0 / 105 |
0.0 ( 0.0 ; 3.5 ) |
Garg ( 2011 ) |
0 / 125 |
0.0 ( 0.0 ; 2.9 ) |
Karimi et al . ( 2012 ) |
1 / 32 |
3.1 ( 0.1 ; 16.2 ) |
|
Total
Overall total
|
187 / 1264 12.5 ( 5.6 ; 24.0 )
529 / 2233 23.8 ( 14.8 ; 35.1 )
|
% transfusion |
18 187 205
342 * 187 529
Figure 3 . Error-bar chart , bimaxillary surgery without 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 .
stable . These series heavily influence the dataset and reflect a shift in transfusion policy . This policy is not new and was already advocated in Germany in 2003 ( Habler et al ., 2007 ). 51 When combining the effects of time and predonation policy , we find an opposite evolution in transfusion policy . The predonation centers have not changed transfusion policy and account for the majority of blood transfusions in this series . Predonation is the most prominent risk factor in bimaxillary surgery to expose a patient to blood transfusion , even if it is autologous blood ( Table 12 , Table 13 ). A similar attitude of liberal transfusion when autologous blood is available has been found in other surgical disciplines with about the same ratio . ( Forgie et al ., 1998 ) 52
When further broken down by author , Table 14 presents the numbers of bimaxillary surgeries ( aggregated figures ) with the corresponding number and percentage of autotransfusions , clearly illustrating the wide variability in transfusion policy towards autologous blood donation . The role of hypotension as critical risk factor for transfusion has been investigated in this series , but this must be regarded as ‘ very low level of evidence ’ because few studies are fully comparable in their mean arterial pressure and in the duration of the mean arterial pressure , or even in the way the mean arterial pressure was measured . When aggregating the data to normotension , controlled hypotensionnot further specified , controlled hypotension mild , controlled hypotension moderate , and controlled
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