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Surgeon- and parent-reported outcome after surgery for craniosynostosis
Subhas Konar1, Joel John1, Dhaval Shukla1
1National Institute of Mental Health and Neurosciences, Department of Neurosurgery, Bengaluru, Karnataka, India.
Insights
This study found that parent-reported outcomes strongly correlate with surgeon assessments after craniosynostosis surgery. Incorporating patient-reported outcome measures (PROMs) is crucial for a comprehensive evaluation of surgical success in children.
Area of Science:
- Pediatric Surgery
- Craniofacial Surgery
- Patient-Reported Outcomes
Background:
- Previous craniosynostosis research primarily focused on surgeon assessments.
- Limited data exists on parent-reported outcomes following surgical correction.
- Parental perspectives are vital for a holistic understanding of surgical success.
Purpose of the Study:
- To assess both surgeon-assessed and parent-reported outcomes in pediatric craniosynostosis surgery.
- To evaluate the correlation between objective surgical outcomes and subjective patient-reported outcome measures (PROMs).
- To emphasize the importance of dual assessment in craniosynostosis treatment evaluation.
Main Methods:
- Retrospective observational study of 103 children undergoing craniosynostosis surgery (2009-2022).
- Surgeon assessment using the Sloan outcome classification system (Class 1-7).
- Non-structured patient-reported outcome measurement (PROM) evaluating cosmesis, vision, symptoms, performance, and quality of life (QOL).
Main Results:
- 56.3% of children achieved excellent surgical correction (Sloan Class 1).
- Metopic synostosis cases showed the highest improvement rates (85.7%).
- Strong correlation observed between surgeon outcomes and PROM domains (cosmesis, QOL).
- Significant differences in PROM results between syndromic and nonsyndromic groups were noted.
Conclusions:
- Parent-reported outcomes align significantly with surgeon assessments in craniosynostosis surgery.
- Patient-reported outcome measures (PROMs) provide essential subjective data.
- Integrating both objective and subjective assessments offers a comprehensive evaluation of surgical outcomes.
Abstract:
While previous studies have focused on quantitative assessments and surgeon-reported surgical outcomes, limited research exists on parent-reported outcomes following surgical correction of craniosynostosis. Our study assessed both surgeon-assessed and parent-reported outcomes in children who underwent craniosynostosis correction surgery. A retrospective observational study analyzed the outcomes of 103 children who underwent craniosynostosis surgery between January 2009 and June 2022. First the surgeon assessed the outcome using the Sloan outcome classification system, which ranks cosmetic results on a six-point ordinal scale ranging from excellent correction (Class 1) to compromised correction requiring revision surgery (Class 7). Second, a non-structured patient-reported outcome measurement (PROM) evaluating subjective postoperative changes in cosmetic appearance, vision, oropharyngeal symptoms, scholastic performance, and quality of life (QOL) for both the child and parent was carried out. PROM responses were categorized as A (worsened), B (unchanged), C (moderately improved), or D (significantly improved). Fifty-eight children (56.3 %) achieved a Sloan Class 1 outcome, indicating excellent correction with no visible or palpable deformity. Children with metopic suture synostosis showed the highest improvement (85.7 %). Subjective outcome assessment using PROM revealed statistically significant differences between syndromic (S) and nonsyndromic (NS) craniosynostosis groups across multiple domains. There was a strong correlation between surgeon-reported outcomes and PROM domains of cosmesis, as well as parent and child quality of life. Our study highlights the importance of incorporating both objective and subjective measures in assessing outcomes of craniosynostosis surgery.
