Blood Transfusion Rates in Non-syndromic Craniosynostosis: A Proportion Meta-analysis of Open Versus Minimally Invasive Techniques.

OBJECTIVES

Premature suture fusion in non-syndromic craniosynostosis often requires surgery to permit normal brain growth. To minimize blood transfusion requirements, minimally invasive surgery (MIS) has been proposed. This study will pool the prevalence of blood transfusion in non-syndromic craniosynostosis surgeries, comparing open surgery (OS) with MISs.

METHODS

A systematic review and proportion meta-analysis was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and registered in PROSPERO (CRD42024604632). PubMed, Scilit, Scopus, and Web of Science were searched up to 7 March 2024. Pooled prevalence was calculated using the Freeman-Tukey double arcsine transformation.

RESULTS

Nine studies with a total of 619 patients met the inclusion criteria. The pooled prevalence of blood transfusion was 52.0% (95% CI: 32.0-72.0) for OS and 10.0% (95% CI: 1.0-20.0) for MIS. Within OS, cranial vault remodeling exhibited the highest transfusion prevalence of 58.1% (95% CI: 37.5-78.7). Among those undergoing MIS, strip-assisted surgery had a lower prevalence (3.9%; 95% CI: -0.5-8.2) compared to endoscopic strip craniectomy (13.1%; 95% CI: -0.4-26.6). OS for metopic craniosynostosis yielded a blood transfusion prevalence of 76.2% (95% CI: 62.9-89.5), the highest among affected sutures. Sagittal craniosynostosis repairs showed a prevalence of 22.5% (95% CI: 9.6-35.3) in OS, compared with 2.6% (95% CI: 1.7-11.9) in MIS.

CONCLUSIONS

The prevalence of blood transfusion in craniosynostosis repair is significantly lower in MIS compared to OS, suggesting the relative safety of MIS in terms of transfusion risks.