Catastrophic and Critical Intraoperative Events during Pediatric Craniofacial Surgery

Area of Science:

• Pediatric Surgery
• Craniofacial Surgery
• Patient Safety

Background:

• Pediatric craniofacial surgery in tertiary centers is generally safe with low mortality.
• Complex cases can still lead to catastrophic and life-threatening intraoperative events.
• This study investigates the incidence and outcomes of such critical events.

Purpose of the Study:

• To determine the incidence of catastrophic and critical intraoperative events during pediatric craniofacial surgery.
• To analyze the acute outcomes of these events.
• To evaluate the effectiveness of management strategies in a high-volume center.

Main Methods:

• Review of 7214 procedures performed by two senior surgeons over 18 years (2002-2019).
• Identification of catastrophic or critical intraoperative events requiring emergency code activation.
• Analysis of operative details and acute outcomes for 14 identified events.

Main Results:

• A total of 14 critical events (0.67% incidence) occurred in 7214 procedures.
• Events included venous air embolism, cardiac complications, major hemorrhage, and trigeminocardiac reflex.
• No mortalities were recorded; surgery was curtailed in 7 cases and completed in 7.

Conclusions:

• Catastrophic, life-threatening events in pediatric craniofacial surgery are infrequent.
• Experienced surgical and anesthesia teams effectively managed critical intraoperative events, preventing mortality.
• This highlights the importance of specialized teams in high-volume pediatric craniofacial centers.