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Midface Hypoplasia and Cranial Base Morphology in Syndromic Craniosynostosis: A Comparative Analysis Study Using a Predictive Regression Model
Published on: November 4, 2025
Analysis of routine intensive care unit admission following fronto-orbital advancement for craniosynostosis
Mitchel Seruya1, Tina M Sauerhammer, Deniz Basci
1Washington, D.C. From the Departments of Plastic Surgery and Neurosurgery at Children's National Medical Center and the George Washington School of Medicine.
Insights
Routine intensive care unit admission after fronto-orbital advancement for craniosynostosis is questioned. Only 4.7% of infants required intensive care unit care, with predictors including end-organ dysfunction and blood loss.
Area of Science:
- Pediatric Surgery
- Craniofacial Surgery
- Intensive Care Medicine
Background:
- Fronto-orbital advancement is a common procedure for craniosynostosis.
- Postoperative intensive care unit (ICU) admission is standard practice.
- This study evaluates the necessity of routine ICU care.
Purpose of the Study:
- To determine the frequency of postoperative events necessitating ICU care after fronto-orbital advancement.
- To identify predictors of major adverse events.
- To assess the justification for routine ICU admission.
Main Methods:
- Retrospective review of infants undergoing fronto-orbital advancement (1997-2011).
- Data collected included demographics, operative factors, and hemodynamic outcomes.
- Postoperative events were graded: none (I), minor (II), or major (III, requiring ICU care).
Main Results:
- 107 infants were analyzed; 4.7% experienced major events requiring ICU care.
- Major events included prolonged intubation and reintubation.
- Preexisting end-organ dysfunction and increased intraoperative blood loss were associated with major events.
Conclusions:
- A small percentage of patients require ICU care post-fronto-orbital advancement.
- Selective ICU admission may be considered, but potential risks on the surgical floor must be weighed.
- Predictors for ICU admission include end-organ dysfunction and significant blood loss.
Background:
Intensive care unit admission following fronto-orbital advancement for craniosynostosis is routine at most institutions. The authors determined the frequency of postoperative events requiring intensive care unit care that justify this practice.
Methods:
Infants with craniosynostosis who underwent primary fronto-orbital advancement at a single institution from 1997 to 2011 were included. Patient demographics, operative factors, and hemodynamic outcomes were recorded. Adverse postoperative events/interventions were graded as none (group I); minor (group II), easily managed on a surgical floor; or major (group III), requiring intensive care unit care.
Results:
One hundred seven infants were included. Average length of hospitalization was 3.7 ± 1.6 days, with 1.3 ± 1.0 days in the intensive care unit and 2.4 ± 1.0 days on the floor. Seventy-eight patients (72.9 percent) were categorized into group I, 24 (22.4 percent) into group II, and five (4.7 percent) into group III. Major events/interventions included prolonged intubation (n = 2), reintubation (n = 2), and continuous positive airway pressure support (n = 1). Preexisting end-organ dysfunction was significantly associated with group III patients, who also had significantly higher intraoperative blood loss requiring greater resuscitation. Mean daily charges were $7652.33 (10.9 percent of total charges) for intensive care unit care and $2470.62 (6.9 percent of total charges) for floor care.
Conclusions:
In this study, 4.7 percent of patients had event/interventions requiring intensive care unit care after fronto-orbital advancement. Predictors included preexisting end-organ dysfunction and higher intraoperative blood loss requiring greater resuscitation. Financial savings from selective postoperative intensive care unit admission may not outweigh the potential cost of an emergent event on the surgical floor.
