National Database Reported Outcomes Following Craniosynostosis Reconstruction

Abstract

Background: While there has been ample interest and literature published regarding craniosynostosis surgical technique, there are few reports on adverse hospital and health system outcomes. The purpose of this study was to describe rate of and risk factors for complications, and adverse outcomes following craniosynostosis reconstruction. Methods: This study retrospectively reviewed the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Pediatric database and identified all patients undergoing craniosynostosis repair from 2012 to 2016. Univariate logistic regression analysis was used to identify significant associations between preoperative risk factors and adverse outcomes. Multivariate logistic regression analysis was then used to identify independent risk factors and causes of prolonged operative times, transfusions, reoperation, prolonged length of hospital stays, and readmission. Results: There were 3924 patients included who underwent craniosynostosis repair, of whom 1732 underwent frontoorbital advancement and 2192 underwent cranial vault remodeling. Transfusion was the most common NSQIP reportable outcome, occurring for 66.5% of all patients. The incidence of reoperation was 2.4% and readmission was 3.0%. Conclusion: This study provides a large descriptive analysis of craniosynostosis repair throughout the United States. Largely nonmodifiable patient risk factors lead to worse health system metrics, with young age, gastrointestinal comorbidities, American Society of Anesthesiologist scores of 3 and greater, reoperation, and a prolonged length of stay as independent risk factors for readmission. This analysis can be used to identify the standard of practice in synostosis care and enhance the implementation of ancillary care services to provide safe and cost-effective care for patients undergoing craniosynostosis repair.

Long-term Outcomes of Non-syndromic and Syndromic Craniosynostosis: Analysis of Demographic, Morphologic, and Surgical Factors

“…According to previous reports, the incidence of repeat surgery widely varied from 0% to 39% (Table 4). 19,20,[22][23][24][25][26][27] However, the previous reports included short-term follow-up of patients, and the average follow-up period was 4.4-13.2 years, which is much shorter than that in this study. It is difficult to conclude the incidence of repeat surgery for craniosynostosis according to such short-term follow-up studies.…”

“…17) Although many surgical procedures have been introduced in the past four decades, 18) there are few reports on long-term postoperative outcomes in craniosynostosis. [19][20][21][22][23][24][25][26][27] Furthermore, there are almost no reports that denote the procedures for optimizing longterm outcomes in syndromic and non-syndromic cases, although outcomes may differ between the two types of the disease. Therefore, in this study, we retrospectively analyzed the long-term outcomes of children with craniosynostosis who were followed for at least 5 years after surgery and attempted to determine the prognosis in syndromic and non-syndromic groups.…”

Early Adverse Events Following Pediatric Mandibular Advancement: Analysis of the ACS NSQIP-Pediatric Database

“…Despite the inherent flaws of any large multiinstitutional database, the utility of the NSQIP-Pediatric database should not be discounted. This resource has been used not only to assess outcomes of surgical procedures performed by numerous specialties (Paine et al, 2016a; Paine et al, 2016b; Roxbury et al, 2017; Mets et al, 2019; Marston et al, 2019; Massenburg et al, 2020; Patel et al, 2020; Moroco et al, 2020) but also to identify areas for quality improvement across fields (Shah et al, 2014). This resource does not seek to include all surgical cases at participating institutions, but rather a representative sample (Shah et al, 2014).…”

Evaluation of Complications and Outcomes in Craniosynostosis by Age of Operation: Analysis of the National Surgical Quality Improvement Program-Pediatric

“…10,20,39,40 Fronto-orbital advancement was also associated with longer hospital stays, as well as higher rates of reoperation and 30-day readmission. 20 In our analysis, there was no difference in total blood transfused across age groups in the FOA cohort, but there was a significant increase in bleeding in the CVR group. This is consistent with the relatively high rates of transfusion, operative length, and length of stay seen in our study for patients older than 6 months.…”

“…Study subjects were retrospectively selected from the American College of Surgeons NSQIP-P database 21,22 between 2012 and 2019. Subject identification utilized previously published methodology to identify craniosynostosis patients in the NSQIP-P. 20…”