Perioperative Outcomes and Surgical Case Volume in Pediatric Complex Cranial Vault Reconstruction: A Multicenter Observational Study From the Pediatric Craniofacial Collaborative Group.


  • Retrospective multicentre observational study of paediatric patients undergoing complex cranial vault reconstruction across 33 North-American institutions
  • Institutions were categorised into low, middle or high surgical case volume
  • Low surgical case volumes were associated with increased total blood donor exposures and increased perioperative transfusion volumes
  • There was no difference in hospital length of stay or major post operative outcomes

Take Home Messages

  • The authors claim their findings highlight the opportunity for improvement in perioperative blood management in lower volume centres for craniofacial surgery
  • Although this may be true and the findings were statistically significant, the actual difference in blood volumes transfused between different sized institutions were small
  • This study does not explain whether the differences in transfusion volumes reflects surgical experience and technique, institutional differences in transfusion triggers or whether there is better multidisciplinary perioperative blood management in larger centres.
  • Reducing blood transfusions is logical and in the ideal world we would have a consistent approach to blood management across institutions
  • Achieving this is complex and expensive, and this paper alone does not prove that lower transfusion rates results in better outcomes with regards to major complications and length of hospital stay
  • Therefore we need further evidence of patient benefit before embarking on this task

Reviewed by: Dr. M. Tan