An audit investigating blood loss in Orthognathic surgery
Shayma Witwit1, Geoff Chiu2
1 Dental Core Trainee, 2 Consultant Oral and Maxillofacial Surgeon, Derby Royal Hospital
Orthognathic surgery is an elective procedure performed to alter the relationship between the maxilla and mandible in order to improve function, speech and appearance.
Intra operative bleeding is abundant and occasionally transfusion is necessary 1. There is a clear benefit to patients in minimising blood loss. Some of the effective haemostatic adjuncts used in orthognathic surgery are hypotensive anaesthesia and tranexamic acid 2.
To ensure standards of best practice are being met by minimising intra operative blood loss for orthognathic surgery.
1) Ninety percent (90%) of patients should not require blood transfusion 1 2) The average estimated blood loss (EBL) should be 437.5 ml or less. 3
All patients undergoing either a single or double jaw surgery were included in this prospective audit. The estimated volume blood loss (EBL) was recorded at the end of each procedure having subtracted the volume of any irrigants used. In the second cycle of the audit, 1g of IV tranexamic acid (TA) was administered to patients preoperatively.
In the first cycle 7 of 50 (14%) patients had blood loss exceeding 437ml, Falling short of the standard by 4%. Following implementation of TA all patients (100%) had blood loss less than 437ml – meeting the standard set.
The results show that single jaw procedures were associated with a lower EBL than double jaw. Following the first cycle, the results demonstrate a 50% reduction in intra operative EBL for double jaw and 30% reduction in single jaw following implementation of IV TA.
The efficacy of TXA in orthognathic surgery has been widely reported in the literature.4 It can reduce the need for blood transfusion and therefore reduce the risks associated with blood transfusion such as infection, fluid overload and incorrect blood transfusions being given5.
NICE guidance5 states that all adults that are undergoing surgery and expected to have moderate blood loss (> 500ml) should be offered TXA. This audit demonstrates a significant reduction in bleeding in the second cycle and a shift towards better practice by implementation of IV TA. A suggestion for re-audit has been on an annual basis.