Factors influencing blood loss in fronto-orbital advancement and remodeling: A retrospective review of 231 cases.

Fronto-orbital advancement and remodeling (FOAR) is associated with substantial blood loss, making it crucial to understand the factors influencing intraoperative blood loss during this procedure. A total of 231 craniosynostosis patients who underwent FOAR between 2003 and 2023 were retrospectively reviewed. Younger patients (<18 months) demonstrated higher weight-adjusted blood loss. Patients with multiple suture synostosis, syndromic craniosynostosis, elevated intracranial pressure (ICP), and dural tears had significantly higher total and weight-adjusted blood loss. Blood loss showed a moderate positive correlation with operative time. Additionally, patients administered tranexamic acid during surgery experienced significantly lower blood loss. Multiple linear regression analysis identified the presence of a syndrome, dural tears, and operative time as statistically significant predictors of both total and weight-adjusted blood loss. Patients with higher intraoperative transfusion volumes demonstrated a continued higher need for transfusions during the postoperative period. In conclusion, significant risk factors for increased blood loss during FOAR include syndromic craniosynostosis, multiple suture synostosis, elevated ICP, dural tears, and prolonged operative time. Tranexamic acid demonstrates beneficial effects in reducing blood loss. Patients requiring higher intraoperative transfusion volumes should be closely monitored postoperatively for ongoing transfusion needs. Clinicians should consider these risk factors and adjust their approaches to enhance patient safety.