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Pediatric Rapid Fire Abstract

Pediatrics

Blood Conservation Strategies and Surgical Techniques in Pediatric Neurosurgery: A Systematic Review and Meta-Analysis

Sunday, May 5, 2024
4:17 PM – 4:19 PM CT
Location:  S405b
Disclosure(s):
Sanjay V. Neerukonda, BS: No financial relationships to disclose
Michael Farid, BSE: No financial relationships to disclose
Sukul Mittal, BS: No financial relationships to disclose
Introduction: While transfusion is commonly indicated in neurosurgical practice, there is a lack of standardized guidelines in the pediatric population. We aim to synthesize available evidence to recommend optimal blood conservation strategies in pediatric patients undergoing neurosurgery for craniosynostosis.

Methods: A systematic review was conducted using PubMed, Google Scholar, and SCOPUS according to PRISMA guidelines to assess primary articles on the use of blood conservation strategies to minimize blood loss in pediatric neurosurgery. Network meta-analysis analytical approach (Frequentist and Bayesian) was undertaken to calculate the overall Risk Difference (RD) and Standardized Mean Difference (SMD) for various outcome metrics amongst the various treatments and compared to placebo.

Results: 33 articles meeting our search criteria were analyzed with 22 studies included in the final meta-analysis. Of the agents EACA, EPO+iron, EPO+iron+TXA, and TXA, TXA alone was found to be effective in decreasing mean intraoperative blood loss compared to placebo (SMD: -1.26, 95%-CI: [-1.97,-0.56]). Regarding mean intraoperative transfused volume, usage of aprotinin (SMD: -1.10, 95%-Cl: [-2.50,-0.14]), EACA (SMD: -0.52, 95%-Cl: [-0.97,-0.07]), and TXA (SMD: -0.83, 95%-Cl: [-1.13,-0.54]) all led to significant reductions compared to placebo. Studies that reported use of ACA+EPO had a 67% lower transfusion rate on average compared to placebo (RD: -0.67, 95%-Cl: [-1.00,-0.34]); EPO+iron 47% lower (RD: -0.47, 95%-Cl: [-0.84,-0.09]); EPO+iron+TXA 86% lower (RD: -0.86, 95%-Cl: [-1.109,-0.62]); and TXA 8% lower (RD: -0.08, 95%-Cl: [-0.15,-0.02]). Surgery lengths and complication rates were not found to differ significantly between any blood conservation agent and placebo.

Conclusion : While ACA+EPO was the most effective agent in lowering transfusion rates when compared to placebo, TXA was able to not only lower transfusion rates but was also effective in reducing both intraoperative blood loss and transfusion volume in pediatric neurosurgeries for craniosynostosis patients.