Discussion: A European Multicenter Outcome Study of Perioperative Airway Management Policies following Midface Surgery in Syndromic Craniosynostosis

Abstract

I n this multicenter study, Cuperus et al. present compelling evidence to support the safety of immediate extubation for the majority of children with syndromic synostosis undergoing midface advancement, irrespective of the procedure type. 1 The authors highlight a notable reduction in pneumonia complications associated with immediate postoperative extubation. While the conclusions are robust, the authors wisely emphasize the need for careful consideration of the distinct characteristics of individual patients with syndromic craniosynostosis.This excellent study sheds light on a wellestablished yet consistently intriguing aspect of surgical practice: the influence of routine. In 2005, Fearon reported long-term results in his personal series of 51 Le Fort III procedures on patients with syndromic craniosynostosis. 2 In that report, which predates the current study by 20 years, Fearon reported a practice change from delayed extubation to immediate extubation in the majority of his patients around 2.5 years into the 5-year study. The effect of this personal practice change reduced both intensive care unit and hospital length of stay. In a multicenter study on perioperative outcomes and protocols in 11 institutions across the United States, the Pediatric Craniofacial Collaborative Group reported that 42% of patients with syndromic craniosynostosis undergoing midface advancement surgery were immediately extubated, contrasting with 23% of the current European cohort. 3 The proportion of patients who were treated with delayed extubation was relatively similar to that of the current study, at 45.8% of the American cohort and 59% of the European cohort. Although 21% of patients in the American cohort presented with preexisting