Benefits of Antifibrinolytics in Minimally Invasive Surgical Repair of Single-suture Craniosynostosis.

Abstract

<h4>Background</h4>The utility of antifibrinolytics in minimally invasive craniosynostosis repair lacks established consensus. This study aimed to assess the impact of antifibrinolytic administration on intraoperative blood loss; length of hospital stay; operative time; complications; and blood transfusion frequency, volume, and management in infants undergoing minimally invasive surgical repair of single-suture craniosynostosis.<h4>Methods</h4>A single institution retrospective cohort study was performed on children who underwent minimally invasive craniosynostosis repair from 2007 to 2023. Patients were divided into groups based on antifibrinolytic administration status. Calculated blood loss was determined from a formula based on red cell mass. Intraoperative transfusion management was evaluated, considering transfusion volumes appropriate within 15% of preoperative red cell mass.<h4>Results</h4>Eighty-five patients were included: 40 received antifibrinolytics, and 45 did not. No significant differences were found in demographics, complications, or transfusion volume. The mean weight-adjusted calculated blood loss (38.93 versus 62.89 mL/kg, <i>P</i> = 0.001), length of hospital stay (1.5 versus 2.2 d, <i>P</i> < 0.0001), mean operative time (81.2 versus 99.6 min, <i>P</i> = 0.0001), and transfusion rate were all significantly lower in the antifibrinolytic group (42.5% versus 95.6%, <i>P</i> < 0.0001). Patients in the antifibrinolytic group were undertransfused at discharge at higher rates (62.5% versus 26.7%, <i>P</i> = 0.0009).<h4>Conclusions</h4>The findings support the safety and efficacy of antifibrinolytic administration in minimally invasive craniosynostosis repair, significantly reducing blood loss, operative time, and hospital stay. Their use is recommended in minimally invasive craniosynostosis repair, with emphasis on transfusion strategies aligned to blood volume loss.