Prevalence and Impact of Complications on Hospitalization Outcomes Following Surgical Repair for Craniosynostosis

doi:10.1016/j.joms.2014.05.005

Journal of Oral and Maxillofacial Surgery

Volume 72, Issue 12, December 2014, Pages 2522-2530

https://doi.org/10.1016/j.joms.2014.05.005 Get rights and content

Purpose

The objective of the present study was to examine the association between different types of complications and hospitalization outcomes in patients having surgical repair for craniosynostosis.

Materials and Methods

The Nationwide Inpatient Sample for 2004 through 2010 was used. All patients up to 3 years old who underwent surgical repair for craniosynostosis were selected for analysis. The primary independent variable was occurrence of different types of complications. The outcomes of interest included hospital charges and length of hospital stay.

Results

During the study period, 17,788 hospitalizations concerned a surgical repair for craniosynostosis. Most procedures were performed in those younger than 1 year (77.7% of hospitalizations). Female patients comprised 65.2% of hospitalizations. After hospitalization, 98% were discharged routinely. Fifteen patients died in the hospital. Complications occurred in 10.1% of hospitalizations. The 5 frequently reported complications were hemorrhage (4.1%); iatrogenically induced complications, including accidental punctures, lacerations, or pneumothorax (3.1%); cardiac complications (0.7%); bacterial infections (0.7%); and respiratory complications (0.7%). Patients who developed nonhealing wounds, hemorrhages, infections, iatrogenically induced complications, respiratory complications, nervous system complications, and cardiac complication were associated with significantly higher hospitalization charges, whereas those who developed septicemia, bacterial infections, mycoses, hemorrhage, other infections, iatrogenically induced complications, vascular complications, digestive system complications, nervous system complications, and postoperative pneumonia were associated with significantly longer duration of hospital stay (P < .05).

Conclusions

Catastrophic adverse outcomes, such as in-hospital mortality, were reported in 0.08% of patients who underwent surgical repair of craniosynostosis. When complications occurred, they were associated with significantly higher hospital charges and longer length of hospital stay.

Section snippets

Description of Database

The Nationwide Inpatient Sample (NIS) for 2004 through 2010 was used for the present study.¹⁰ The NIS database is a part of the Healthcare Cost and Utilization Project (HCUP) group of databases sponsored by the Agency for Healthcare Research and Quality (AHRQ). The NIS is a 20% stratified probability sample of all acute-care nonfederal hospitals in the United States.¹⁰ The sample frame is based on location, geographic region, bed count, teaching status, and ownership and control of a hospital.

Results

During the study period, 17,788 hospitalizations concerned a surgical repair for craniosynostosis. Surgical procedures included opening of cranial sutures (n = 6,383), repair of the skull with a flap (n = 2,461), bone graft to the skull (n = 3,486), and other cranial osteoplasty (n = 11,046). Patient characteristics are presented in Table 1. Most procedures were performed in those younger than 1 year (77.7% of hospitalizations). Female patients comprised 65.2% of hospitalizations. With regard

Discussion

The largest all-payer hospitalization database in the United States was used to provide nationally representative estimates of hospitalization outcomes associated with surgical procedures for craniosynostosis from 2004 through 2010. Most prior studies examining outcomes after surgical repairs of craniosynostosis have been reports from single-institution studies.5, 6, 7, 8, 9 Esparza et al5, 6 examined complications in 306 consecutively treated patients who underwent transcranial procedures from

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Cited by (19)

Use of Neural Network model to examine post-operative infections following orthognathic surgeries in the United States
2021, Seminars in Orthodontics
Citation Excerpt :
Clinical interventions and post-operative care should be tailored to those identified as high risk cohorts to minimize infections. In our earlier studies, we have used traditional analytical methods such as logistic and linear regression models to demonstrate the impact of infections on outcomes such as mortality, costs and length of stay in hospital across a wide range of surgical procedures and medical conditions and the present report builds on our earlier findings.16–20 To our knowledge, there is a paucity of studies that have provided nationally representative estimates of rare events such as systemic infections following orthognathic surgeries and none have used Neural Network models.21,22
Objective: The objective of this report is to identify predictors of systemic infections following orthognathic surgeries. We test the hypothesis Neural Network models are better at predicting infections compared to traditional analytical models while using a large number of predictor variables. Methods: The Nationwide Inpatient Sample for the years 2006 to 2014 was used. All patients who had a jaw anomaly and underwent an orthognathic surgery were selected. Two models: Neural Network model and multivariable logistic regression model fit with the Maximum Likelihood method were used to predict systemic infections. Results: 55,839 orthognathic surgeries for maxillary/mandibular hyperplasia/hypoplasia required hospitalization in the United States. The overall systemic infection rate was 1.1%. The success rate for accurately predicting the occurrence of an infection was 98.7% by the Neural Network model. The top six predictors included: age, co-morbid condition of fluid and electrolyte disorders, year of procedure, race, deficiency anemia, and mandibular osteoplasty/segmental or subapical osteotomy. The multivariable logistic regression model had poor goodness of fit. Conclusions: Neural Network model is better at predicting systemic infections following orthognathic surgeries when compared to a traditional analytical model such as multivariable logistic regression approach while using a large set of predictor variables in a nationwide database.
Predictors of perioperative complications in paediatric cranial vault reconstruction surgery: a multicentre observational study from the Pediatric Craniofacial Collaborative Group
2019, British Journal of Anaesthesia
The current incidence of major complications in paediatric craniofacial surgery in North America has not been accurately defined. In this report, the Pediatric Craniofacial Collaborative Group evaluates the incidence and determines the independent predictors of major perioperative complications using a multicentre database.
The Pediatric Craniofacial Surgery Perioperative Registry was queried for subjects undergoing complex cranial vault reconstruction surgery over a 5-year period. Major perioperative complications were identified through a structured a priori consensus process. Logistic regression was applied to identify predictors of a major perioperative complication with bootstrapping to evaluate discrimination accuracy and provide internal validity of the multivariable model.
A total of 1814 patients from 33 institutions in the US and Canada were analysed; 15% were reported to have a major perioperative complication. Multivariable predictors included ASA physical status 3 or 4 (P=0.005), craniofacial syndrome (P=0.008), antifibrinolytic administered (P=0.003), blood product transfusion >50 ml kg^–1 (P<0.001), and surgery duration over 5 h (P<0.001). Bootstrapping indicated that the predictive algorithm had good internal validity and excellent discrimination and model performance. A perioperative complication was estimated to increase the hospital length of stay by an average of 3 days (P<0.001).
The predictive algorithm can be used as a prognostic tool to risk stratify patients and thereby potentially reduce morbidity and mortality. Craniofacial teams can utilise these predictors of complications to identify high-risk patients. Based on this information, further prospective quality improvement initiatives may decrease complications, and reduce morbidity and mortality.
Iatrogenic Pseudoaneurysm of Superficial Temporal Artery After Surgery for Scaphocephaly: Case Report and Review of Literature
2018, World Neurosurgery
Citation Excerpt :
Craniosynostosis is a disease consisting of the premature fusion of ≥1 sutures of the skull, resulting in deforming modifications of skull growth pattern. This condition affects 1 in 2000–2500 live births worldwide.3,4 Since the skull cannot grow perpendicular to the pathologic sutures, it expands in a parallel direction.5
Iatrogenic pseudoaneurysm of the superficial temporal artery after surgery for craniosynostosis is a complication that has never been described in the pertinent literature. Although reported for other types of surgeries, no case has been described in the pediatric population.
We report on a case of pseudoaneurysm of the superficial temporal artery that occurred 9 days after corrective surgery for scaphocephaly. We also describe the management of this complication.
Pseudoaneurysm is an exceptional complication in surgery for craniosynostosis, but it should be considered in case of swelling in the temporal region.
Orthognathic Surgical Outcomes in Patients With and Without Craniofacial Anomalies
2018, Journal of Oral and Maxillofacial Surgery
Citation Excerpt :
The outcome variables of interest included the occurrence of complications, billed hospital charges, and length of stay. Complications were identified based on the existing literature using the NIS databases.7-9 Two composite variables (occurrence of an infectious complication and occurrence of any type of complication) were created for assessing complications occurring in the study population.
The objective of this study is to examine hospitalization outcomes after orthognathic surgery. This study tests the hypothesis that patients with craniofacial anomalies have higher billed hospital charges, longer lengths of stay, and increased odds of development of infectious complications when compared with patients without craniofacial anomalies.
The Nationwide Inpatient Sample for the years 2012 and 2013 was used. All patients who underwent an orthognathic surgical procedure were selected. The primary independent variable of interest was presence of a congenital cleft and/or craniofacial anomaly. The outcome variables were the occurrence of complications, billed hospital charges, and length of stay. Multivariable logistic and linear regression models were used to examine the effect of the presence of craniofacial anomalies on outcomes.
During the study period, a total of 16,515 patients underwent an orthognathic surgical procedure in the United States. Of these patients, 2,760 had a cleft and/or craniofacial anomaly. An infectious complication occurred in 7.4% of those with a craniofacial anomaly (compared with 0.6% of those without a craniofacial anomaly). The mean billed hospital charges in those with a craniofacial anomaly was $139,317 (compared with $56,189 in those without a craniofacial anomaly). The mean length of stay in the hospital in patients with a craniofacial anomaly was 8.8 days (compared with 1.8 days in those without a craniofacial anomaly). These differences in outcomes between patients with and patients without craniofacial anomalies were significant after we adjusted for patient- and hospital-level confounders.
Patients with a craniofacial anomaly are at higher risk of development of infectious complications, have higher hospital charges, and stay in the hospital for a longer duration after orthognathic surgery when compared with those without a craniofacial anomaly.
Impact of hypothermia during craniosynostosis repair surgery
2016, Revista Colombiana de Anestesiologia
La hipotermia es un reconocido factor de riesgo de complicaciones perioperatorias en pacientes pediátricos. Para el estudio de sus impactos, las cirugías de alto riesgo quirúrgico se comportan como un modelo de exposición a dicho factor de riesgo. En este punto, la corrección quirúrgica de craneosinostosis se comporta como un modelo para la medición de los impactos de la hipotermia.
Evaluar morbimortalidad relacionada con hipotermia en pacientes pediátricos llevados a corrección de craneosinostosis.
Estudio de cohorte histórico en pacientes pediátricos llevados a corrección de craneosinostosis expuestos a hipotermia.
Previa aprobación del Comité de Ética Institucional, incluimos 54 registros en el análisis. No encontramos diferencias estadísticamente significativas entre hipotermia e impactos en términos de morbimortalidad (mortalidad, hemorragia severa, hemorragia masiva, transfusión masiva, coagulación intravascular diseminada, necesidad de soporte vasopresor y tiempos de ventilación mecánica, y hospitalización, incluso en cuidado intensivo). Hallamos un aumento clínicamente significativo en la hemorragia (severa y masiva) e hipotermia severa (28,6 vs. 40% y 14,3 vs. 40%, respectivamente).
La hipotermia severa (y moderada a severa) no demostró en nuestros pacientes diferencias estadísticas para morbimortalidad.
Hypothermia is recognized as a risk factor for perioperative complications in paediatric patients. High surgical risk procedures serve as a model of exposure to that risk factor. In particular, surgical correction of craniosynostosis serves as a model for measuring the impact of hypothermia.
To assess hypothermia-related morbidity and mortality in paediatric patients taken to craniosynostosis correction.
Historical cohort study of patients taken to craniosynostosis correction and exposed to hypothermia.
With prior approval of the Ethics Committee of the institution, 54 records were included in the analysis. No statistically significant differences were found between hypothermia and its impact in terms of morbidity and mortality (death, major bleeding, massive haemorrhage massive transfusion, disseminated intravascular coagulation, need for vasopressor support, mechanical ventilation time and length of stay, including admission to the intensive care unit). A clinically significant increase in bleeding (severe and massive) and severe hypothermia was found (28.6 vs. 40% and 14.3 vs. 40%, respectively).
No statistical differences were found in terms of morbidity and mortality with severe hypothermia (and moderate/severe hypothermia).
Correlation between Demographic Variables and Complications in Nonsyndromic Craniosynostosis
2023, Journal of Craniofacial Surgery

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Craniomaxillofacial deformities/cosmetic surgeryPrevalence and Impact of Complications on Hospitalization Outcomes Following Surgical Repair for Craniosynostosis

Purpose

Materials and Methods

Results

Conclusions

Section snippets

Description of Database

Results

Discussion

J Clin Epidemiol

Neurocirugia (Astur)

Surgery

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

J Oral Maxillofac Surg

Cranial sutures: A brief review

Plast Reconstr Surg

A population-based study of craniosynostosis in metropolitan Atlanta, 1989-2003

Am J Med Genet

Management of craniosynostosis

Plast Reconstr Surg

Complications in the surgical treatment of craniosynostosis and craniofacial syndromes: Apropos of 306 transcranial procedures

Childs Nerv Syst

Craniomaxillofacial deformities/cosmetic surgery
Prevalence and Impact of Complications on Hospitalization Outcomes Following Surgical Repair for Craniosynostosis