The Road to Transfusion-free Craniosynostosis Repair in Children Less Than 24 Months Old: A Quality Improvement Initiative

Amy B. Beethe, Rachel A. Spitznagel, Jane A. Kugler, Jessica K Goeller, Marcellene H. Franzen, Ryan J. Hamlin, Thomas J. Lockhart, Elizabeth R. Lyden, Kimberly R. Glogowski, Michelle M. Leriger

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Introduction: Pediatric craniofacial reconstruction has historically resulted in extensive blood loss necessitating transfusion. This single-center quality improvement initiative evaluates the impact of perioperative practice changes on the allogeneic transfusion rate for children 24 months and younger of age undergoing craniofacial reconstruction. Methods: At project initiation, an appointed core group of anesthesiologists provided all intraoperative anesthetic care for patients undergoing craniofacial reconstruction. Standardized anesthetic guidelines established consistency between providers. Using the Plan-do-check-act methodology, practice changes had been implemented and studied over a 5-year period. Improvement initiatives included developing a temperature-management protocol, using a postoperative transfusion protocol, administering intraoperative tranexamic acid, and a preincisional injection of 0.25% lidocaine with epinephrine. For each year of the project, we acquired data for intraoperative and postoperative allogeneic transfusion rates. Results: A cohort of 119 pediatric patients, ages 4-24 months, underwent anterior or posterior vault reconstruction for craniosynostosis at a tertiary children's hospital between March 2013 and November 2018. Intraoperative and postoperative transfusion of allogeneic blood products in this cohort decreased from 100% preintervention to 22.7% postintervention. Conclusions: Interdepartmental collaboration and practice modifications using sequential Plan-do-check-act cycles resulted in a bundle of care that leads to a sustainable decrease in the rate of intraoperative and postoperative allogeneic blood transfusions in patients less than 24 months of age undergoing craniosynostosis repair. This bundle decreases the risk of transfusion-related morbidity for these patients. Other institutions looking to achieve similar outcomes can implement this project.

Original languageEnglish (US)
Article numbere331
JournalPediatric Quality and Safety
Issue number4
StatePublished - Jul 10 2020

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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