Effect of Perioperative Management on Outcome of Patients after Craniosynostosis Surgery
Abdoljalil Kalantar Hormozi1, Nastaran Mahdavi2, Mohammad Mehdi Foroozanfar2
1Department of Craniomaxillofacial Surgery, Mofid Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Insights
Perioperative bleeding and infection significantly prolong intensive care unit (ICU) stays for craniosynostosis patients. Careful management of blood loss and infection control are crucial for improving patient outcomes after cranial reconstruction surgery.
Area of Science:
- Pediatric Neurosurgery
- Craniofacial Surgery
- Intensive Care Medicine
Background:
- Craniosynostosis, premature cranial suture fusion, causes skull deformities.
- Surgical outcomes and intensive care unit (ICU) stays are influenced by surgical techniques and perioperative care.
- Identifying perioperative risk factors is essential for optimizing patient outcomes.
Purpose of the Study:
- To determine perioperative risk factors impacting patient outcomes after craniosynostosis surgery.
- To analyze the association between postoperative complications and the length of ICU stay.
Main Methods:
- Retrospective study of 178 patients undergoing primary cranial reconstruction for craniosynostosis.
- Analysis of postoperative complications including fever, level of consciousness, re-intubation, and cultures.
- Statistical analysis of factors associated with length of ICU stay.
Main Results:
- Fever, perioperative bleeding, age over 5 years at surgery, and infection were independently associated with longer ICU stays.
- Patients with longer ICU stays (over 4 days) had significantly higher mean blood loss during surgery.
- Blood loss correlated with surgery duration and patient age.
Conclusions:
- Perioperative management, especially blood loss, significantly impacts patient outcomes and ICU length of stay.
- Infections acquired in the ICU can also worsen patient outcomes.
- Optimizing perioperative care, including minimizing blood loss and preventing infections, is vital for craniosynostosis patients.
Background:
Craniosynostosis results from premature closure of one or more cranial sutures, leading to deformed calvaria and craniofacial skeleton at birth. Postoperative complications and outcome in intensive care unit (ICU) is related to surgical method and perioperative management. This study determined the perioperative risk factors, which affect outcome of patients after craniosynostosis surgery.
Methods:
In a retrospective study, 178 patients with craniosynostosis who underwent primary cranial reconstruction were included. Postoperative complications following neurosurgical procedures including fever in ICU, level of consciousness, re-intubation, and blood, urine, and other cultures were also performed and their association with the main outcomes (length of ICU stay) were analyzed.
Results:
Factors independently associated with a longer pediatric ICU stay were fever (OR=1.59, 95% CI=1.25-4.32; p=0.001), perioperative bleeding (OR=2.25, 95% CI=1.65-3.65; p=0.01), age (having surgery after the first 5 years) (OR=1.59, 95% CI=1.33-3.54, p=0.016) and infection (OR=2.17, 95% CI=1.83-7.46; p=0.002). Mean blood loss during surgery was significantly higher in patients whose duration of ICU was longer than 4 days compare to less than 4 day (p=0.026). Amount of bleeding significantly was correlated to duration of surgery (r=0.70, p=0.001) and patient's age (r=0.23, p=0.44).
Conclusion:
perioperative management particularly blood loss could deteriorate patients outcome and length of stay in ICU and hospital. Infections in ICU could deteriorate outcomes.
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