Predictors of Postoperative Complications of Craniosynostosis Repair in the National Inpatient Sample. (May 2018)

• Record Type: Journal Article
• Authors: Abraham, Peter; Brandel, Michael G.; Dalle Ore, Cecilia L.; Reid, Chris M.; Kpaduwa, Chinwe S.; Lance, Samuel; Meltzer, Hal S.; Gosman, Amanda A.
• Is Part Of: Annals of plastic surgery. Volume 80(2018)Supplement 5 5S
• Publication Date: 2018-05
• Subjects: fronto-orbital advancement -- craniosynostosis -- cranial vault -- timing; Surgery, Plastic -- Periodicals; 617.95205
• DOI: 10.1097/SAP.0000000000001383
• Languages: English
• ISSNs: 0148-7043

Abstract

Abstract : Introduction: Timing of intervention and complication profiles in surgical repair of craniosynostosis have been widely debated. Early intervention is frequently promoted as a means of decreasing morbidity while maintaining favorable outcomes via minimally invasive techniques such as endoscopic strip craniectomy. Immediate postoperative morbidity due to complications of early vs late intervention remains a key element in comparing timing and technique for craniosynostosis repair. In addition, concurrent fronto-orbital advancement with open cranial vault remodeling may increase the risk of postoperative complications. We present an evaluation of surgical timing and the presence of fronto-orbital advancement as independent predictors of in-hospital complications after craniosynostosis repair. Methods: Retrospective analysis was performed in the National Inpatient Sample database from 1998 to 2009. Patients younger than 3 years having undergone elective surgical repair for craniosynostosis were identified. Comorbidities, demographics, transfusion status, and syndromic diagnosis were included as covariates. A multivariate regression model was used to characterize the association between age at the time of surgery and in-hospital complications. A subgroup analysis using the variable of concurrent fronto-orbital advancement was restricted to patients 8 to 24 months of age to exclude endoscopic craniosynostosis repair, which is traditionally repaired less than 6 months of age. Multivariate logistic regression was used to assess the impact of concurrent fronto-orbital advancement on postoperative complications. Results: A total of 6010 craniosynostosis surgery cases (42.9%, age 0–7 months; 29.5%, age 8–12 months; and 27.6%, age 13–36 months) were included. Patients in the 7-to 12-month age group were more likely to experience complications when compared with the 0- to 6-month age group (odds ratio [OR], 1.32; P < 0.05) and 13-to 36-month age group (OR, 1.32; P = 0.056). Syndromic patients (OR, 1.92; P < 0.001) and patients receiving an intraoperative blood transfusion (OR, 1.60; P < 0.05) demonstrated an increased risk for complications. In the subanalysis of 2936 patients aged 8 to 24 months, 15.1% of patients received frontoorbital advancement, which was associated with a significantly increased risk of complications (OR, 1.43; P < 0.05). Conclusions: Intermediate age (7–12 months) and concurrent fronto-orbital repair were independent risk factors for immediate postoperative complications. These findings may better inform the decision-making process for craniosynostosis repair in terms of timing and need for concurrent fronto-orbital reconstruction.