title: Analysis of Morbidity, Readmission, and Reoperation After Craniosynostosis Repair in Children.
abstract: The impact of specific patient comorbidities on outcomes in craniosynostosis surgical repair is not well defined. The aim of this retrospective review was to evaluate the short-term 30-day reoperation rate, unplanned readmission rate, and overall morbidity of craniosynostosis surgical repair using the 2012 through 2014 American College of Surgeons National Surgical Quality Improvement Program-Pediatrics (ACS NSQIP-Pediatric) database. Overall morbidity included pneumonia, wound occurrence, shock/sepsis, venous thromboembolism, cardiac complication, renal and urinary complications, or nerve injury. The authors identified patients undergoing craniosynostosis repair by CPT code resulting in 2,037 patients. A univariate and multivariate analysis was performed to identify risk factors for reoperation, readmission, and morbidity. The reoperation rate was 2.4%, the overall morbidity rate was 2.8%, and readmission rate was 3.4%.Regression analysis identified age, high American Society of Anesthesiologists (ASA) classification, and history of either neurologic or pulmonary disorders as associated with unplanned reoperations within 30 days. High ASA classification also demonstrated significant correlation with unplanned 30-day readmission, and a history of neurologic disorders was associated with overall morbidity. The most common reason for readmission was wound complications (n = 15) followed by respiratory complications (n = 7). Gender, gastrointestinal comorbidities, blood disorders, cardiac risk factors, and prior operation within 30 days did not show significant association with any outcome. Craniosynostosis surgical repair is safe and associated with low complication and readmission rates. Careful patient selection and preoperative optimization of these factors should be sought to reduce detrimental outcomes.
authors.affiliation: Division of Plastic Surgery, Baylor College of Medicine, Houston, TX.
authors.forename: Kevin T
authors.initials: KT
authors.lastname: Jubbal
authors.forename: Nikhil
authors.initials: N
authors.lastname: Agrawal
authors.forename: Larry H
authors.initials: LH
authors.lastname: Hollier
mesh_terms: D002675:Child, Preschool; D015897:Comorbidity; D003398:Craniosynostoses / Q000453:epidemiology / Q000601:surgery; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D015999:Multivariate Analysis; D009422:Nervous System Diseases / Q000453:epidemiology*; D010359:Patient Readmission / Q000706:statistics & numerical data; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology / Q000601:surgery; D058996:Quality Improvement; D012086:Reoperation / Q000379:methods / Q000706:statistics & numerical data; D012140:Respiratory Tract Diseases / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013781:Texas / Q000453:epidemiology; D055815:Young Adult