Syndromic Craniosynostosis: The Hidden Burden of Comorbidities on Surgical Outcomes

Craniosynostosis can occur as an isolated condition or as part of syndromic craniosynostosis (SC), which is commonly associated with various comorbidities complicating clinical management. This study aims to analyze the impact of these comorbidities on postoperative complications following calvarial vault remodeling (CVR) in patients with SC.

We conducted a retrospective review of patients with SC who underwent CVR at a tertiary children's hospital from 2002 to 2024. Demographics, comorbidities, and postoperative complications were recorded. Outcomes of interest included readmission, reoperation, and prolonged postoperative stays (over 7 days). Statistical analyses utilized χ2 tests, t tests, univariate linear regression, and multivariate logistic regression.

Eighty-six patients were analyzed, including those with Apert (27.9%), Crouzon (27.9%), Pfeiffer (14%), Saethre-Chotzen (10.5%), and Muenke (5.8%) syndromes. The average age at surgery was 12.4 months. Cardiac, respiratory, and gastrointestinal comorbidities were present in 12.8%, 31.4%, and 3.5% of patients, respectively; 14% were tracheostomy dependent. Postoperative complications occurred in 38.4% of patients, with all comorbidity types significantly increasing the risk of complications. In particular, the presence of respiratory comorbidities increased the likelihood of cerebrospinal fluid leaks (4.2 times, P = 0.047), hematoma (6.5 times, P = 0.005), and acute postoperative infection (5 times, P = 0.044). Tracheostomy dependence was associated with a sixfold increase in postoperative infections (P = 0.008). Gastrointestinal comorbidities were also correlated with higher rates of seromas (P < 0.001). Cardiac comorbidities were broadly correlated with overall complication rate (P = 0.012). Reoperation rates and prolonged stays were linked to respiratory comorbidities and tracheostomy status (P < 0.001 for both), whereas readmission rates showed no significant association to any comorbidity (P = 0.7).

The presence of comorbidities in SC patients significantly impacted CVR postoperative outcomes. Respiratory issues placed patients at especially high risk of complications, underscoring the importance of thorough preoperative evaluation and tailored management to enhance patient outcomes.