Perioperative transfusion management in craniotomies: a national survey, a starting point for the evaluation of improvements in health care

Objective: To assess the perioperative management of haemostasis and transfusion practices in adult patients undergoing craniotomies.

Method: Online questionnaire addressed to Spanish anaesthesiologists and promoted by the Neurosciences and Haemostasis, Transfusion Medicine and Fluid Therapy Sections of SEDAR. The questionnaire was sent by email and social media, and was active between June and October 2022.

Results: We obtained 155 responses from 67 centres; 59.4% perform >100 craniotomies per year. 61.7% were regularly involved in neuroanaesthesiology. Only 21.9% of respondents had pre-anaesthesia assessment performed by a member of that section, and in most of them (83.0%) the assessment was performed ≤3 weeks in advance. Of the respondents with Patient Blood Management programmes, 58.2% had no specific protocols for craniotomies. 90.3% reported that haemoconcentrates are systematically reserved. A lower platelet limit of 100,000/mcL is considered acceptable by 76.8%. 99.4% of respondents discontinued antiplatelet medication based on half-life. Only 23.9% respondents routinely discontinued non-steroidal anti-inflammatory drugs. The transfusion threshold for haemoglobin during surgical bleeding was <10 g/dL in 18.7%, <9 g/dL in 38.1%, <8 g/dL in 38.7% and <7 g/dL in 4.5%.

Conclusions: Preoperative anaemia screening and treatment programmes are not implemented and blood product reserves are systematised in patients scheduled for craniotomy. Anti-aggregation therapy is discontinued according to the half-life of the drug without checking platelet functionality.