title: Analysis of routine intensive care unit admission following fronto-orbital advancement for craniosynostosis.
abstract: BACKGROUND
  Intensive care unit admission following fronto-orbital advancement for craniosynostosis is routine at most institutions. The authors determined the frequency of postoperative events requiring intensive care unit care that justify this practice.
  
  
  METHODS
  Infants with craniosynostosis who underwent primary fronto-orbital advancement at a single institution from 1997 to 2011 were included. Patient demographics, operative factors, and hemodynamic outcomes were recorded. Adverse postoperative events/interventions were graded as none (group I); minor (group II), easily managed on a surgical floor; or major (group III), requiring intensive care unit care.
  
  
  RESULTS
  One hundred seven infants were included. Average length of hospitalization was 3.7 ± 1.6 days, with 1.3 ± 1.0 days in the intensive care unit and 2.4 ± 1.0 days on the floor. Seventy-eight patients (72.9 percent) were categorized into group I, 24 (22.4 percent) into group II, and five (4.7 percent) into group III. Major events/interventions included prolonged intubation (n = 2), reintubation (n = 2), and continuous positive airway pressure support (n = 1). Preexisting end-organ dysfunction was significantly associated with group III patients, who also had significantly higher intraoperative blood loss requiring greater resuscitation. Mean daily charges were $7652.33 (10.9 percent of total charges) for intensive care unit care and $2470.62 (6.9 percent of total charges) for floor care.
  
  
  CONCLUSIONS
  In this study, 4.7 percent of patients had event/interventions requiring intensive care unit care after fronto-orbital advancement. Predictors included preexisting end-organ dysfunction and higher intraoperative blood loss requiring greater resuscitation. Financial savings from selective postoperative intensive care unit admission may not outweigh the potential cost of an emergent event on the surgical floor.
authors.affiliation: Washington, D.C. From the Departments of Plastic Surgery and Neurosurgery at Children's National Medical Center and the George Washington School of Medicine.
authors.forename: Mitchel
authors.initials: M
authors.lastname: Seruya
authors.forename: Tina M
authors.initials: TM
authors.lastname: Sauerhammer
authors.forename: Deniz
authors.initials: D
authors.lastname: Basci
authors.forename: Gary F
authors.initials: GF
authors.lastname: Rogers
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Boyajian
authors.forename: John S
authors.initials: JS
authors.lastname: Myseros
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Yaun
authors.forename: Robert F
authors.initials: RF
authors.lastname: Keating
authors.forename: Albert K
authors.initials: AK
authors.lastname: Oh
mesh_terms: D003398:Craniosynostoses / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007362:Intensive Care Units; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods*; D010343:Patient Admission / Q000706:statistics & numerical data*; D010865:Pilot Projects; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies
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