Blood Transfusions in Orthognathic Surgery

Objectives: Orthognathic surgery is the surgical correction of abnormalities of the mandible, maxilla, or both. Since craniofacial structures are very vascular, one complication of orthognathic surgery is intraoperative blood loss (BL). In general, as a routine standard of practice for elective surgery, preoperative autologous blood donation (PABD) is done for all patients. If autologous blood is not used during surgery, it is wasted and cannot be transfused to other patients. If blood is needed, a homologous blood donation is used. Given that most patients undergoing orthognathic surgery are young and healthy, there is debate in literature about PABD for orthognathic surgery. The objective of this retrospective chart review study is to analyze if PABD is necessary for orthognathic surgeries and if there are certain factors that predispose patients to increased BL.
Methods: This study was conducted in the Department of Oral Surgery at Tufts University School of Dental Medicine. Following IRB approval, medical records from patients who underwent orthognathic surgery in the past 5 years (2010-2015) were reviewed. The following variables were analyzed: Demographic data, Medical history, BMI, Hemoglobin concentrations, Number of units of blood cross-matched and used, Length of operation, Grade of anesthetist, History of complications, Type of Orthognathic surgery, Amount of BL.
Results: 100 charts were reviewed, with close to equal gender distribution (Females-51%, Males-49%). The age distribution was 14-59, and a majority underwent BSSO, LeFort, and Genioplasty procedures. that the records show that autologous blood was not transfused in any patients who underwent orthognathic surgery during the five years reviewed. The association between amount of BL and analysis variables was calculated using Spearman correlation. There was weak association between variables analyzed and amount of BL during the procedure.
Conclusions: Due to the weak association between factors and low occurrence of complications, PABD is not supported in most cases.