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Frequency and predictors of concurrent complications in multi-suture release for syndromic craniosynostosis
Sujay Rajkumar1, Daniel S Ikeda2, Michaela Scanlon2,3
1Drexel University School of Medicine, Philadelphia, PA, USA.
Insights
Concurrent complications after craniosynostosis surgery in syndromic children are linked to cardiac and pulmonary issues, not surgical factors. Preoperative nutritional support also increases risk, aiding in better risk assessment.
Area of Science:
- Pediatric Surgery
- Craniofacial Surgery
- Surgical Outcomes Research
Background:
- Craniosynostosis surgery in syndromic children involves complex multi-suture repairs.
- Understanding co-occurring perioperative complications is crucial for patient safety.
- Limited data exists on concurrent complication patterns in this specific pediatric population.
Purpose of the Study:
- To investigate the incidence and patterns of concurrent perioperative complications in syndromic children undergoing multi-suture craniosynostosis repair.
- To identify predictive factors associated with these concurrent complications.
- To explore the relationship between complications and patient outcomes.
Main Methods:
- Retrospective cohort study utilizing the National Surgical Quality Improvement Program-Pediatric database (2012-2020).
- Inclusion criteria: children with syndromic diagnoses and multi-suture craniosynostosis requiring surgery.
- Analysis focused on concurrent complications, associated factors, and correlations with outcomes.
Main Results:
- Out of 5,848 children, 2.75% experienced concurrent complications (two or more).
- Bleeding/transfusion was the most frequent single complication (69.53%).
- Key independent predictors for concurrent complications included cardiac risk factors, previous cardiac surgery, preoperative ventilator dependence, structural pulmonary/airway abnormalities, and nutritional support.
Conclusions:
- Cardiac and pulmonary comorbidities, along with preoperative nutritional support, are significant independent predictors of concurrent complications in syndromic craniosynostosis surgery.
- Procedural factors were not found to be independently associated with concurrent complications.
- Findings can enhance presurgical counseling and risk stratification for these complex pediatric cases.
Purpose:
Understanding the complication profile of craniosynostosis surgery is important, yet little is known about complication co-occurrence in syndromic children after multi-suture craniosynostosis surgery. We examined concurrent perioperative complications and predictive factors in this population.
Methods:
In this retrospective cohort study, children with syndromic diagnoses and multi-suture involvement who underwent craniosynostosis surgery in 2012-2020 were identified from the National Surgical Quality Improvement Program-Pediatric database. The primary outcome was concurrent complications; factors associated with concurrent complications were identified. Correlations between complications and patient outcomes were assessed.
Results:
Among 5,848 children identified, 161 children (2.75%) had concurrent complications: 129 (2.21%) experienced two complications and 32 (0.55%) experienced ≥ 3. The most frequent complication was bleeding/transfusion (69.53%). The most common concurrent complications were transfusion/superficial infection (27.95%) and transfusion/deep incisional infection (13.04%) or transfusion/sepsis (13.04%). Two cardiac factors (major cardiac risk factors (odds ratio (OR) 3.50 [1.92-6.38]) and previous cardiac surgery (OR 4.87 [2.36-10.04])), two pulmonary factors (preoperative ventilator dependence (OR 3.27 [1.16-9.21]) and structural pulmonary/airway abnormalities (OR 2.89 [2.05-4.08])), and preoperative nutritional support (OR 4.05 [2.34-7.01]) were independently associated with concurrent complications. Children who received blood transfusion had higher odds of deep surgical site infection (OR 4.62 [1.08-19.73]; p = 0.04).
Conclusions:
Our results indicate that several cardiac and pulmonary risk factors, along with preoperative nutritional support, were independently associated with concurrent complications but procedural factors were not. This information can help inform presurgical counseling and preoperative risk stratification in this population.
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