title: Subgaleal Drain Placement Improves Surgical Outcomes After Primary Cranioplasty in Craniosynostosis Patients.
abstract: BACKGROUND
  There is no published data addressing the use of postoperative subgaleal drains in patients undergoing primary cranioplasty for craniosynostosis. We conducted a retrospective chart review in this population of patients, comparing outcomes of those who received postoperative drains with those who did not. We hypothesize that the subgaleal drains can significantly diminish postoperative facial edema and reduce the length of hospital stay.
  
  
  METHODS
  We conducted a retrospective chart review of all patients undergoing primary cranioplasty for craniosynostosis with subgaleal drain placement (May 2010-March 2012). A comparison group without drain placement was matched appropriately to establish a comparison of outcomes. We determined whether subgaleal drainage led to improvement in postoperative facial edema, reduced length of hospital stay, postoperative changes in hematocrit (Hct), and complication rates.
  
  
  RESULTS
  Of the 50 patients in this cohort, 25 patients had received subgaleal drains. The mean length of stay was 2.4 versus 3.5 days for the respective drained and undrained cohorts (P = 0.03). There was no significant difference in the mean decline in Hct between drained and undrained patients, with the mean Hct drop of 4.8% versus 5.0%, respectively (P = 0.83). Postoperative seroma formation developed in 3 undrained patients (17%) versus none in the drained cohort (0%). Although subjective, drained patients were observed to achieve quicker resolution of facial swelling and earlier recovery of eye opening.
  
  
  CONCLUSIONS
  There is clinical benefit in subgaleal drain placement as earlier resolution of postoperative facial edema and a significantly shortened length of hospital stay was found among the drained cohort. Future studies warrant prospective clinical trials to establish the safety and efficacy of using subgaleal drains in cranial remodeling procedures of craniosynostosis.
authors.affiliation: Center for Craniofacial Disorders, Rady Children's Hospital, San Diego, CA.
authors.forename: J W
authors.initials: JW
authors.lastname: Tong
authors.forename: Jessica K
authors.initials: JK
authors.lastname: Emelin
authors.forename: Ryan
authors.initials: R
authors.lastname: Wong
authors.forename: Hal S
authors.initials: HS
authors.lastname: Meltzer
authors.forename: Steven Roy
authors.initials: SR
authors.lastname: Cohen
mesh_terms: D016022:Case-Control Studies; D015331:Cohort Studies; D003398:Craniosynostoses / Q000601:surgery*; D003399:Craniotomy / Q000379:methods*; D004322:Drainage / Q000295:instrumentation* / Q000379:methods; D004487:Edema / Q000517:prevention & control; D005260:Female; D006400:Hematocrit; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D061646:Operative Time; D011183:Postoperative Complications / Q000517:prevention & control; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D049291:Seroma / Q000209:etiology; D016896:Treatment Outcome