title: Major morbidity and mortality rates in craniofacial surgery: an analysis of 8101 major procedures.
abstract: BACKGROUND
  The first combined evaluation of morbidity and mortality rates in craniofacial surgery was published 30 years ago; many surgeons believe these procedures have since become safer. The authors performed a contemporary evaluation of craniofacial morbidity and mortality rates to help surgeons more accurately counsel families about current risks, and to gain insight into reducing future incidences.
  
  
  METHODS
  This study used two methodologies to capture all serious morbidities and mortalities associated with major craniofacial procedures between 1990 and 2008: a comprehensive two-center retrospective review (Dallas and Seattle), and an Internet-based survey sent to all North American craniofacial centers.
  
  
  RESULTS
  Combining the two-center data with the survey results yielded a database of 7328 intracranial and 773 subcranial procedures, for a total of 8101 major craniofacial procedures. The combined intracranial major morbidity rate was less than 0.1 percent, and the combined mortality rate was 0.1 percent. Of the eight perioperative deaths following intracranial procedures, four (50 percent) intracranial mortalities were directly attributed to blood loss. The combined subcranial procedure major morbidity rate was 0.1 percent and the mortality rate was 0.3 percent (airway related). Comparing the earliest published intracranial mortality rate to our current review revealed a statistically significant reduction in incidence (p < 0.001).
  
  
  CONCLUSIONS
  The incidence rates for serious morbidities and mortalities among major craniofacial procedures have significantly fallen since first published. On the basis of these analyses, the authors believe that a greater focus on protocols for airway management, blood salvage and replacement, age-appropriate deep venous thrombosis prophylaxis, and timing of subcranial midfacial advancements might result in further reductions in craniofacial mortality rates.
authors.affiliation: Dallas Texas; and Seattle, Wash. From The Craniofacial Center and the Seattle Children's Craniofacial Center.
authors.forename: Marcin
authors.initials: M
authors.lastname: Czerwinski
authors.forename: Richard A
authors.initials: RA
authors.lastname: Hopper
authors.forename: Joseph
authors.initials: J
authors.lastname: Gruss
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Fearon
mesh_terms: D019465:Craniofacial Abnormalities / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D009017:Morbidity / Q000639:trends; D019637:Orthopedic Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology*; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology