Postoperative care after craniofacial surgery: evaluation of routine laboratory testing.
In this study, two protocols for monitoring children after major craniofacial surgery were compared. The first protocol consisted of repetitive laboratory testing in 37 children to detect surgical and medical complications during a 2-year period. None of the complications were predicted by abnormal test results, and abnormal results of routinely performed tests never led to a change in management. The second protocol, an adapted version of the first protocol, was continued for 5 years as a prospective study in 98 children: Patients were routinely tested only once, and further testing was initiated either after an abnormal test result or because of clinical symptoms. Clinical management and the incidence of postoperative complications did not differ between groups. The second protocol considerably reduced the mean number of tests per patient from 42.5 to 7.0, but in contrast with the first protocol, 84 percent of abnormal test results led to changes in clinical management. In conclusion, in the first group the test results were not used and were not predictive of complications. In the second group, tests were more apt to have abnormal results and often initiated treatment. This shows that indiscriminate routine laboratory testing is of limited value in covering the postoperative period after craniofacial surgery.
van Krugten
R J
RJ
Department of Pediatric Surgery, Sophia Children's Hospital, Rotterdam, The Netherlands.
Bos
A P
AP
Offringa
M
M
Tibboel
D
D
Molenaar
J C
JC
D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D003365:Costs and Cost Analysis; D003399:Craniotomy / Q000379:methods; D003422:Critical Care / Q000191:economics; D003955:Diagnostic Tests, Routine / Q000191:economics; D004827:Epilepsy / Q000209:etiology; D005145:Face / Q000002:abnormalities* / Q000601:surgery*; D006801:Humans; D007223:Infant; D010027:Osteotomy / Q000379:methods; D011141:Polyuria / Q000209:etiology; D011182:Postoperative Care / Q000191:economics; D011183:Postoperative Complications / Q000175:diagnosis*; D011446:Prospective Studies; D012886:Skull / Q000002:abnormalities* / Q000601:surgery*