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An audit investigating intraoperative blood loss in Orthognathic surgery

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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 

 

Background

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

Standard

To ensure standards of best practice are being met by minimising intra operative blood loss for orthognathic surgery.

Standard:

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

Methods

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.

Discussion

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. 

Conclusion

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. 

References

1)Faverani LP, Ramalho-Ferreira G. Intraoperative blood loss and transfusion requirements in patients undergoing Orthognathic Surgery. Oral and Maxillofacial Surgery. 2014 [internet] [cited 2017 March 7]; 18(3): 305–310. Available from URL: http://link.springer.com/article/10.1007/s10006-013-0415-4
2)Thastum M. Factors influencing intraoperative blood loss in orthognathic surgery. International Journal of Oral and Maxillofacial Surgery. 2016 [internet] [cited 2017 March 07]; 45(9): 1070-1073. Available from URL: https://hdas.nice.org.uk/strategy/160852/1/PubMed/27055979
3)Pineiro A, Somoza-Martín, Manuel, Gándara-Rey, José, García-García, Abel. Blood Loss in Orthognathic Surgery: A Systematic Review. Journal of oral and maxillofacial surgery : Journal of the American Association of Oral and Maxillofacial Surgeons (2010) 69(3):885-92
4)Song G, Yang P, Hu J, Zhu S, Li Y, Wang Q, G, 2013. The effect of tranexamic acid on blood loss in orthognathic surgery: a meta-analysis of randomized controlled trials. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology 2013, [online]. 115(5), 595-600. Available at: https://www.ncbi.nlm.nih.gov/books/NBK174097/ [Accessed 20 March 2018].
5)NICE. 2016. Blood transfusion. Quality statement 2: Tranexamic acid for adults. [online] Available at: https://www.nice.org.uk/guidance/qs138/chapter/quality-statement-2-tranexamic-acid-for-adults. [Accessed 20 March 2018].

 

 

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