Oğuz DURSUN, Mehmet Saim KAZAN, Ercan MIHÇI, Banu NUR, Ebru Atike ONGUN

Early postoperative follow-up after craniosynostosis surgery

Background/aim: Declined morbidity rates after craniosynostosis surgery indicate bypassing the pediatric intensive care unit (PICU)course to minimize treatment costs and bed usage. The aim of this study is to examine the incident rates of PICU admission and assessits necessity.Materials and methods: A retrospective analysis of 41 patients (operated on by open surgical techniques) between July 2011 andDecember 2015 was carried out. Intraoperative/postoperative vital signs, hemodynamic and metabolic parameters, estimated blood loss(EBVloss), blood transfusions, length of PICU, and hospitalizations were recorded.Results: Major and minor events reached 51.2% and 82.9%, respectively. EBVloss within 24 h was calculated as 39.58 ± 8.19 (median:38.44, 25.68–66.34) with 75.6% blood transfusion rate. Hypotension and hypothermia were associated with prolonged surgery (P =0.001 and P = 0.007, respectively), but were not related to age (P = 0.054, P = 0.162) or procedure types (P = 0.558, P = 0.663). Prolongedsurgery and younger age had an impact on the complications. One patient died of persistent hemorrhage at 96 h.Conclusion: Monitoring cardiovascular and metabolic dynamics at PICU during the first 24 h after surgery is crucial. Additional studiesare needed to define the threshold values of several metabolic and hemodynamic markers in risk assessment after cranial vault surgery.

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Akingbola OA, Singh D, Srivastav SK, Walsh JW, Jansen DA, Frieberg EM. Intensive care unit course of infants and children after cranial vault reconstruction for craniosynostosis. BMC Res Notes 2011; 4: 347.
Goobie SM, Zurakowski D, Proctor MR, Meara JG, Meier PM, Young VJ, Rogers GF. Predictors of clinically significant postoperative events after open craniosynostosis surgery. Anesthesiology 2015; 122: 1021-1032.
Honeycutt JH. Endoscopic-assisted craniosynostosis surgery. Semin Plast Surg 2014; 28: 144-149.
Lee HQ, Hutson JM, Wray AC, Lo PA, Chong DK, Holmes AD, Greensmith AL. Analysis of morbidity and mortality in surgical management of craniosynostosis. J Craniofac Surg 2012; 23: 1256-1261.
Lin Y, Pan IW, Mayer RR, Lam S. Complications after craniosynostosis surgery: comparison of the 2012 Kids’ Inpatient Database and Pediatric NSQIP Database. Neurosurg Focus 2015; 39: E11.
Mathijssen IM. Guideline for care of patients with the diagnoses of craniosynostosis: working group on craniosynostosis. J Craniofac Surg 2015; 26: 1735-1807.
Abbott MM, Rogers GF, Proctor MR, Busa K, Meara JG. Cost of treating sagittal synostosis in the first year of life. J Craniofac Surg 2012; 23: 88-93.
Teichgraeber JF, Baumgartner JE, Viviano SL, Gateno J, Xia JJ. Microscopic versus open approach to craniosynostosis: a longterm outcomes comparison. J Craniofac Surg 2014; 25: 1245- 1248.
Vamvakas EC. Long-term survival rate of pediatric patients after blood transfusion. Transfusion 2008; 48: 2478-2480.
Seruya M, Sauerhammer TM, Basci D, Rogers GF, Boyajian MJ, Myseros JS, Yaun AL, Keating RF, Oh AK. Analysis of routine intensive care unit admission following fronto-orbital advancement for craniosynostosis. Plast Reconstr Surg 2013; 131: 582-588.
Stricker PA, Shaw TL, Desouza DG, Hernandez SV, Bartlett SP, Friedman DF, Sesok-Pizzini DA, Jobes DR. Blood loss, replacement, and associated morbidity in infants and children undergoing craniofacial surgery. Paediatr Anaesth 2010; 20: 150-159.
Vogel TW, Woo AS, Kane AA, Patel KB, Naidoo SD, Smyth MD. A comparison of costs associated with endoscope-assisted craniectomy versus open cranial vault repair for infants with sagittal synostosis. J Neurosurg Pediatr 2014; 13: 324-331.
Wes AM, Paliga JT, Goldstein JA, Whitaker LA, Bartlett SP, Taylor JA. An evaluation of complications, revisions, and long-term aesthetic outcomes in nonsyndromic metopic craniosynostosis. Plast Reconstr Surg 2014; 133: 1453-1464.
Hughes C, Thomas K, Johnson D, Das S. Anesthesia for surgery related to craniosynostosis: a review. Part 2. Pediatr Anesth 2013; 23: 22-27.
Carver E, Marcus R, Tatman AF. FFP use in craniofacial surgery. Pediatr Anesth 2010; 20: 471.
Chan JWH, Stewart CL, Stalder MW, St Hilaire H, McBride L, Moses MH. Endoscope-assisted versus open repair of craniosynostosis: a comparison of perioperative cost and risk. J Craniofac Surg 2013; 24: 170-174.
Eaton AC, Marsh JL, Pilgram TK. Transfusion requirements for craniosynostosis surgery in infants. Plast Reconstr Surg 1995; 95: 277-283.
Erb TO, Meier PM. Surgical treatment of craniosynostosis in infants: open vs closed repair. Curr Opin Anesthesiol 2016; 29: 345-351.
Ali A, Basaran B, Tanirgan G, Aydoseli A, Sabanci PA, Sencer A, Telci L, Akinci IO. Metabolic changes and factors influencing base deficit in infants undergoing craniosynostosis surgery: a retrospective study. Acta Neurochir 2015; 157: 1197-1204.
Choi AYS, Ahmad NS, Debeer DAH. Metabolic changes during major craniofacial surgery. Pediatr Anesth 2010; 20: 851-855.
Van Uitert A, Megens JH, Breugem CC, Stubenitsky BM, Han KS, de Graaff JC. Factors influencing blood loss and allogeneic blood transfusion practice in craniosynostosis surgery. Paediatr Anaesth 2011; 21: 1192-1197.
No authors listed: Practice guidelines for blood component therapy: a report by the American Society of Anesthesiologists Task Force on Blood Component Therapy. Anesthesiology 1996; 84: 732-747.
Birgfeld CB, Dufton L, Naumann H, Hopper RA, Gruss JS, Haberkern CM, Speltz ML. Safety of open cranial vault surgery for single-suture craniosynostosis: a case for the multidisciplinary team. J Craniofac Surg 2015; 26: 2052-2058.
Mekitarian Filho E, Brunow de Carvalho W, Cavalheiro S, Horigoshi NK, Freddi NA. Perioperative factors associated with prolonged intensive care unit and hospital length of stay after pediatric neurosurgery. Pediatr Neurosurg 2011; 47: 423- 429.
Barker FG. Efficacy of prophylactic antibiotics against meningitis after craniotomy: a meta-analysis. Neurosurgery 2007; 60: 887-894.
Valentini LG, Casali C, Chatenoud L, Chiaffarino C, Uberti- Foppa C, Broggi G. Surgical site infections after elective neurosurgery: a survey of 1747 patients. Neurosurgery 2007; 61: 88-96.
Hobar PC, Masson JA, Herrera R, Ginsburg CM, Sklar F, Sinn DP, Byrd HS. Fever after craniofacial surgery in the infant under 24 months of age. Plast Reconstr Surg 1998; 102: 32-36.
Goodrich JT. Craniofacial surgery: complications and their prevention. Semin Pediatr Neurol 2004; 11: 288-300.
Tahiri Y, Paliga JT, Wes AM, Whitaker LA, Bartlett SP, Taylor JA. Perioperative complications associated with intracranial procedures in patients with nonsyndromic single-suture craniosynostosis. J Craniofac Surg 2015; 26: 118-123.
Yeung L, Cunningham M, Allpress A, Gruss, JS, Ellenbogen RG, Zerr DM. Surgical site infections after pediatric intracranial surgery for craniofacial malformations: frequency and risk factors. Neurosurgery 2005; 56: 733-739.
Cladis F, Bykowski M, Schmilt E, Naran S, Moritz ML, Cray J, Grunwaldt L, Losee J. Postoperative hyponatremia following calvarial vault remodelling in craniosynostosis. Pediatr Anesth 2011; 21: 1020-1025.
Bennett KG, Bickham RS, Robinson AB, Buchman SR, Vercler CJ. Metopic craniosynostosis: a demographic analysis outside an urban environment. J Craniofac Surg 2016; 27: 544-547.
Lee HQ, Hutson JM, Wray AC, Lo PA, Chong DK, Holmes AD, Greensmith AL. Changing epidemiology of nonsyndromic craniosynostosis and revisiting the risk factors. J Craniofac Surg 2012; 23: 1245-1251.
Van der Meulen J. Metopic synostosis. Childs Nerv Syst 2012; 28: 1359-1367.
Selber J, Reid RR, Chike-Obi CJ, Sutton LN, Zackai EH, McDonald-McGinn D, Sonnad SS, Whitaker LA, Bartlett SP. The changing epidemiologic spectrum of single-suture synostoses. Plast Reconstr Surg 2008; 122: 527-533.
Anderson IA, Goomany A, Bonthron DT, Bellew M, Liddington MI, Smith IM, Russell JL, Carter LM, Guruswamy V, Goodden JR et al. Does patient ethnicity affect site of craniosynostosis? J Neurosurg Pediatr 2014; 14: 682-687.
Farzaneh F, Moradi E, Habibi Z, Nejat F. Ethnicity and craniosynostosis. J Neurosurg Pediatr 2015; 16: 478-479.