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Perioperative Outcomes and Surgical Case Volume in Pediatric Complex Cranial Vault Reconstruction: A Multicenter

Allison M Fernandez1, Srijaya K Reddy2, Heather Gordish-Dressman3

  • 1From the Department of Anesthesia, Perioperative and Pain Medicine, Johns Hopkins All Children's Hospital, St Petersburg, Florida.

Anesthesia and Analgesia
|September 18, 2018
PubMed

Insights

Lower surgical case volumes for complex cranial vault reconstruction (CCVR) correlate with increased blood donor exposures and transfusions. However, CCVR case volume did not significantly impact major complications or hospital stay.

Area of Science:

  • Pediatric Surgery
  • Craniofacial Surgery
  • Healthcare Outcomes Research

Background:

  • Complex cranial vault reconstruction (CCVR) for craniosynostosis can involve substantial blood loss and perioperative complications.
  • Understanding factors influencing these outcomes is crucial for improving patient care.
  • Surgical case volume is a potential factor affecting perioperative results.

Purpose of the Study:

  • To investigate the association between CCVR surgical case volume and perioperative outcomes.
  • To determine if higher surgical case volumes lead to better patient outcomes.
  • To analyze the impact of case volume on blood transfusion requirements and complications.

Main Methods:

  • A multicenter registry data from 33 institutions was analyzed for 1814 CCVR cases (June 2012-September 2016).
  • Institutions were stratified into low, middle, and high surgical case volume groups based on monthly case averages.
  • Primary outcome was perioperative blood donor exposures; secondary outcomes included transfusion volume, major complications, and length of stay.

Main Results:

  • An inverse relationship was found between surgical case volume and perioperative blood donor exposures (P < .001).
  • Low-volume centers exhibited higher perioperative transfusion volumes compared to middle (P = .02) and high-volume centers (P = .01).
  • No significant association was observed between surgical case volume and major postoperative complications or hospital length of stay.

Conclusions:

  • Lower surgical case volumes for CCVR are linked to increased blood donor exposures and transfusion volumes.
  • While transfusion metrics differ, the overall clinical impact on hospital length of stay appears limited across volume groups.
  • These findings suggest that optimizing surgical volume may help reduce transfusion-related outcomes in CCVR.
Abstract

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