From the Divisions of Plastic Surgery and Pediatric Gastroenterology, Indiana University and Riley Hospital for Children.
Plast Reconstr Surg. 2020 Nov;146(5):1119-1127. doi: 10.1097/PRS.0000000000007245.
Recent studies support the prophylactic use of tranexamic acid during craniosynostosis surgery to reduce blood loss. The study aims to assess national trends and outcomes of tranexamic acid administration.
The Pediatric Health Information System database was used to identify patients who underwent craniosynostosis surgery over a 9-year period (2010 to 2018). Search criteria included patients younger than 2 years with a primary diagnosis of craniosynostosis (International Classification of Diseases, Ninth Revision, 756.0; International Classification of Diseases, Tenth Revision, Q75.0) and CPT code for craniotomy (61550 to 61559). Tranexamic acid use, complications, length of stay, and transfusion requirements were recorded. Subgroup analysis was performed for fronto-orbital advancements and single-suture surgery.
A total of 1345 patients were identified. Mean patient age was 229 ± 145 days. Four hundred fifty-four patients (33.7 percent) received tranexamic acid. Tranexamic acid use increased from 13.1 percent in 2010 to 75.6 percent in 2018 (p = 0.005), and mean blood products per patient increased from 1.09 U to 1.6 U (p = 0.009). Surgical complication rate was higher in those receiving tranexamic acid (16.7 percent versus 11.1 percent; p = 0.004). Tranexamic acid administration was associated with increased transfusion requirements on univariate and multivariate analysis (1.76 U versus 1.18 U; OR, 2.03; p < 0.001). In the fronto-orbital advancement subgroup, those receiving tranexamic acid received more total blood products (2.2 U versus 1.8 U; p = 0.02); this difference was present but not significant within the single-suture group (0.69 U versus 0.50 U; p = 0.06).
Tranexamic acid use in craniosynostosis surgery has increased dramatically since 2010. However, it was associated with higher transfusion and complication rates in this data set. Optimization of its use and blood loss mitigation in infant craniosynostosis deserve continued research.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
最近的研究支持在颅缝早闭手术中预防性使用氨甲环酸以减少失血。本研究旨在评估氨甲环酸给药的全国趋势和结果。
使用儿科健康信息系统数据库，在 9 年期间（2010 年至 2018 年）确定接受颅缝早闭手术的患者。搜索标准包括年龄小于 2 岁的患者，其主要诊断为颅缝早闭（国际疾病分类，第 9 版，756.0；国际疾病分类，第 10 版，Q75.0）和颅骨切开术的 CPT 代码（61550 至 61559）。记录氨甲环酸的使用、并发症、住院时间和输血需求。进行了前额眶推进术和单缝手术的亚组分析。
共确定了 1345 名患者。患者平均年龄为 229 ± 145 天。454 名患者（33.7%）接受了氨甲环酸治疗。氨甲环酸的使用率从 2010 年的 13.1%上升到 2018 年的 75.6%（p = 0.005），每位患者的平均血液制品用量从 1.09 U 增加到 1.6 U（p = 0.009）。接受氨甲环酸治疗的患者手术并发症发生率更高（16.7%比 11.1%；p = 0.004）。单因素和多因素分析均显示氨甲环酸给药与输血需求增加相关（1.76 U 比 1.18 U；OR，2.03；p < 0.001）。在前额眶推进术亚组中，接受氨甲环酸治疗的患者接受了更多的总血液制品（2.2 U 比 1.8 U；p = 0.02）；在单缝组中，这一差异虽然存在但不显著（0.69 U 比 0.50 U；p = 0.06）。
自 2010 年以来，氨甲环酸在颅缝早闭手术中的使用急剧增加。然而，在这个数据集，它与更高的输血和并发症发生率相关。优化其在婴儿颅缝早闭中的使用和减少失血值得进一步研究。
临床问题/证据水平：治疗，III。
