Surgical Complications After Fronto-orbital Advancement for Craniosynostosis: Analysis of a National Database

Fronto-orbital advancement (FOA) is the standard surgical intervention for patients with craniosynostosis and associated fronto-orbital dysmorphology. Although previous studies have provided insights into center-specific complications, comprehensive, large-scale analyses remain limited. This study utilizes a national database to address these gaps, offering a large-scale perspective on FOA outcomes.

Patients aged 0 to 16 years who underwent FOA from 2007 to 2015 were identified using the PearlDiver database. Patients were divided into early (0-5 y) and late (6-16 y) groups. Complications were identified using a combination of ICD and CPT codes. Intraoperative complications, including hematoma/hemorrhage, cerebrovascular infarction, and cardiac arrest, were defined as those occurring within 48 hours of the procedure. Postoperative complications analyzed at intervals of 0, 30, 90, 180, and 365 days post-operation included cerebrospinal fluid leak, hardware-related complications, hemorrhage, seizure, surgical site infection, wound dehiscence, and death. Summary statistics were conducted utilizing Bellwether software in PearlDiver.

A total of 2026 patients underwent FOA, with a mean of 1.5 years in the younger cohort (n=1905) and 9.0 years in the older cohort (n=121). Although rare, hemorrhage was the most common intraoperative complication. One-year postoperative complications were predominantly related to wound dehiscence and surgical site infection in the younger (5.10%) and older (14.1%) cohorts. The 1-year reoperation rate was 7.2% for the younger cohort and 19.0% for the older cohort.

FOA is a safe operation with an overall low complication rate. However, older patients demonstrate a higher rate of reoperations, emphasizing the need to identify the optimal timing for FOA in patients with craniosynostosis.