title: Perioperative complications associated with intracranial procedures in patients with nonsyndromic single-suture craniosynostosis.
abstract: Within the diagnosis "craniosynostosis," there is a subset of patients who present with isolated, nonsyndromic, single-suture involvement. This study evaluates perioperative complications in this specific subset of patients over 4 decades at a single institution. To do so, we performed a retrospective review on consecutive patients undergoing correction of single-suture synostosis from May 1977 to January 2013 at a tertiary pediatric craniofacial center. Demographic information, operative details, and perioperative course were collected. Complications were categorized as either major or minor. A χ(2) test and Fisher exact test were used to compare all categorical variables. Continuous variables were analyzed using Wilcoxon rank-sum and Kruskal-Wallis tests.Seven hundred forty-six patients underwent surgical correction of nonsyndromic craniosynostosis. Of these, there were 307 (41.2%) sagittal, 201 (26.9%) metopic, and 238 (31.9%) unicoronal. Thirty-four patients had complications (4.6%). Eight were considered major (1.1%), including one postoperative mortality in a patient with hypoplastic left-sided heart syndrome. Minor complications occurred in 26 patients (3.5%) and included subgaleal hematoma (n = 3), seroma (n = 4), and superficial wound infection (n = 5). Metopic and sagittal suture involvement was significantly associated with a higher complication rate (P = 0.04). A child with isolated single suture synostosis and any comorbidity had a significantly greater risk of any complication (P < 0.001; odds ratio, 3.8) and specifically an increased risk of major complication (P = 0.031; odds ratio, 6.0). Subclassification of patients by time period yielded no statistically significant changes in perioperative morbidity. To conclude, these data allow us to counsel families more accurately with regard to morbidity and mortality and may potentially serve as a benchmark for future quality improvement work.
authors.affiliation: From the *Division of Plastic Surgery, Indiana University, Riley Hospital for Children, Indianapolis, IN; and †Division of Plastic Surgery, The Perelman School of Medicine at the University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Youssef
authors.initials: Y
authors.lastname: Tahiri
authors.forename: James Thomas
authors.initials: JT
authors.lastname: Paliga
authors.forename: Ari M
authors.initials: AM
authors.lastname: Wes
authors.forename: Linton A
authors.initials: LA
authors.lastname: Whitaker
authors.forename: Scott P
authors.initials: SP
authors.lastname: Bartlett
authors.forename: Jesse A
authors.initials: JA
authors.lastname: Taylor
mesh_terms: D002318:Cardiovascular Diseases / Q000150:complications; D002423:Cause of Death; D002675:Child, Preschool; D015331:Cohort Studies; D003393:Cranial Sutures / Q000002:abnormalities; D019465:Craniofacial Abnormalities / Q000150:complications; D003398:Craniosynostoses / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005624:Frontal Bone / Q000002:abnormalities; D005767:Gastrointestinal Diseases / Q000150:complications; D006406:Hematoma / Q000209:etiology; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications; D008297:Male; D010294:Parietal Bone / Q000002:abnormalities; D011183:Postoperative Complications; D012189:Retrospective Studies; D049291:Seroma / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome