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Perioperative Outcomes and Management in Pediatric Complex Cranial Vault Reconstruction: A Multicenter Study from the
Paul A Stricker1, Susan M Goobie, Franklyn P Cladis
1From the Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (P.A.S.); Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts (S.M.G., P.M.M.); Department of Anesthesiology, The Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (F.P.C.); Departments of Anesthesiology and Pain Medicine and Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, D.C. (C.M.H.); Children's National Health System, Division of Anesthesiology, The George Washington University School of Medicine and Health Sciences, Washington, DC (S.K.R.); Department of Anesthesiology, Monroe Carell Jr. Children's Hospital, Vanderbilt University Medical Center, Nashville, Tennessee (T.T.N.); Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania (L.C., M.P.); and Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical School, Children's Medical Center Dallas, Texas and Outcome Research Consortium, Cleveland, Ohio (P.S.).
Insights
Pediatric cranial vault reconstruction for craniosynostosis often requires transfusions, with significant complications noted. Variability in care highlights opportunities for improving surgical outcomes and patient safety.
Area of Science:
- Pediatric Surgery
- Craniofacial Surgery
- Perioperative Medicine
Background:
- The Pediatric Craniofacial Surgery Perioperative Registry was established to study practices and outcomes in pediatric craniosynostosis surgery.
- Complex cranial vault reconstruction in children involves significant perioperative management and potential complications.
Purpose of the Study:
- To determine perioperative management, outcomes, and complications in children undergoing complex cranial vault reconstruction.
- To identify key features of current practices in North America.
Main Methods:
- Data from 31 institutions between June 2012 and September 2015 were analyzed.
- Demographics, perioperative management, length of stay, laboratory results, and blood management techniques were extracted.
- Outcomes included blood transfusion volumes, donor exposures, and length of stay.
Main Results:
- 1,223 cases were analyzed, with 935 patients aged ≤24 months and 288 aged >24 months.
- Transfusion rates were high: 95% for younger children and 79% for older children.
- Notable complications included cardiac arrest, seizures, and unplanned surgeries; no deaths occurred.
Conclusions:
- Complex cranial vault reconstruction in children is frequently associated with blood transfusions.
- Significant complications and variability in management indicate areas for quality improvement.
- Further research is needed to optimize perioperative care and reduce adverse events.
Background:
The Pediatric Craniofacial Collaborative Group established the Pediatric Craniofacial Surgery Perioperative Registry to elucidate practices and outcomes in children with craniosynostosis undergoing complex cranial vault reconstruction and inform quality improvement efforts. The aim of this study is to determine perioperative management, outcomes, and complications in children undergoing complex cranial vault reconstruction across North America and to delineate salient features of current practices.
Methods:
Thirty-one institutions contributed data from June 2012 to September 2015. Data extracted included demographics, perioperative management, length of stay, laboratory results, and blood management techniques employed. Complications and outlier events were described. Outcomes analyzed included total blood donor exposures, intraoperative and perioperative transfusion volumes, and length of stay outcomes.
Results:
One thousand two hundred twenty-three cases were analyzed: 935 children aged less than or equal to 24 months and 288 children aged more than 24 months. Ninety-five percent of children aged less than or equal to 24 months and 79% of children aged more than 24 months received at least one transfusion. There were no deaths. Notable complications included cardiac arrest, postoperative seizures, unplanned postoperative mechanical ventilation, large-volume transfusion, and unplanned second surgeries. Utilization of blood conservation techniques was highly variable.
Conclusions:
The authors present a comprehensive description of perioperative management, outcomes, and complications from a large group of North American children undergoing complex cranial vault reconstruction. Transfusion remains the rule for the vast majority of patients. The occurrence of numerous significant complications together with large variability in perioperative management and outcomes suggest targets for improvement.
