Complications After Craniofacial Surgery: A Review From 2012 to 2020

Objective Craniofacial abnormalities require intensive surgical interventions associated with major risks. This study aimed to analyze how craniofacial surgical outcomes have changed over recent years. Design This was a retrospective, cross-sectional study. Setting Data was collected from the American College of Surgeons' National Surgical Quality Improvement Program Pediatric (NSQIP-P) database. Patients A total of 1730 patients were identified between 2012 and 2020 by searching for CPT code 21175, "reconstruction, bifrontal, superior-lateral orbital rims, and lower forehead, advancement or alteration with or without grafts", in the primary procedure column. Variables of interest included total length of hospital stay (LOS), readmission, and reoperation. Main outcome measures The primary outcome measured was the incidence of postoperative complications. Results The study included 1730 patients, with a mean age of 1.8 + 2.7 years. The most common comorbidities were structural CNS abnormalities (24%), developmental delay or impaired cognitive status (17%), and prematurity (16%). Nearly all patients (N = 1721, 99.5%) had a comorbidity, 1270 (73%) patients required blood transfusion, and 68 (4%) patients experienced another type of complication. The complication rate decreased over time, with 80% of patients experiencing a complication in 2012 and 72% in 2020 (p = 0.008). The mean LOS steadily decreased over that time from 5.3 days to 3.6 days (p < 0.001). The time from operation to discharge also decreased at a similar rate to the total LOS (p < 0.001). There was no significant change in the incidence of readmission (1.9%) or reoperation (2.4%) over time.  Conclusions The LOS and incidence of complications have decreased over time, suggesting improvements in craniofacial surgery practices.