gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Perioperative management of blood transfusions in neurosurgical procedures

Meeting Abstract

  • S. Linsler - Department of Neurosurgery, Saarland University, Homburg/Saar
  • R. Ketter - Department of Neurosurgery, Saarland University, Homburg/Saar
  • H. Eichler - Department of Hemostaseology, Saarland University, Homburg/Saar
  • J. Oertel - Department of Neurosurgery, Saarland University, Homburg/Saar
  • K. Schwerdtfeger - Department of Neurosurgery, Saarland University, Homburg/Saar

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocP 105

DOI: 10.3205/11dgnc326, URN: urn:nbn:de:0183-11dgnc3267

Published: April 28, 2011

© 2011 Linsler et al.
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Outline

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Objective: The perioperative management of blood transfusions in neurosurgical patients is ambiguous. There is only little evidence about the probability of transfusions during neurosurgical procedures although a high probability of transfusion is postulated in many cases. Based on this low level of evidence, we initiated a retrospective analysis in order to investigate the probability of blood transfusions depending on the disease and operative procedure. Secondarily, we assessed a guide for the perioperative management of blood transfusions in our clinic.

Methods: All 3026 patients who were treated in our neurosurgical department between December 2006 and June 2008 were retrospectively analyzed for the administration of erythrocyte concentrates intraoperatively or within two days postoperatively on our neurosurgical ICU. We divided the patients for the following analysis in 11 diagnostic groups: traumatic brain injury (TBI), epidural hematoma, acute subdural hematoma, intracerebral hemorrhage (ICH), intracerebral insult, SAH/aneurysms, tumors of the spine, degenerative diseases of the spine, intracranial and spinal abscess, brain tumors and hydrocehalus. We analyzed the probability of blood transfusion for each group. Based on these data we developed a guide for the preoperative estimation for erythrocyte concentrates.

Results: In the 3026 analyzed patients the probability of blood transfusion per case was 6.48% for acute subdural hematoma (n=108), 6.25% for tumors of the spine (n=80), 4.6% for ICH (n=98), 2.77% for abscess (n=108), 2.38% for TBI (n=162), 2.3% for insults (n=44), 1.45% for SAH/aneurysms (n=206), 1.39% for brain tumors (n=718), 0.8% for hydrocephalus (n=196), 0.4% for degenerative diseases of the spine (n=1290), 0% for epidural hematoma (n=15).

Conclusions: The probability of blood transfusion during neurosurgical procedures is well below 10%, which is the generally defined limit as found in the literature for preoperative appropriation of erythrocyte concentrates as well as with respect to preparation and education of the patient. The highest probability of transfusion exists for patients with tumors of the spine and acute subdural hematomas or ICH. Large decompressive procedures of the bone or tissue – often as an emergency procedure – usually require transfusions. Based on our results we created a guide for the perioperative management of blood transfusions and a guide for the preoperative estimation of erythrocyte concentrates in our neurosurgical department.