title: Effect of Perioperative Management on Outcome of Patients after Craniosynostosis Surgery.
abstract: BACKGROUND
  Craniosynostosis results from premature closure of one or more cranial sutures, leading to deformed calvaria and craniofacial skeleton at birth. Postoperative complications and outcome in intensive care unit (ICU) is related to surgical method and perioperative management. This study determined the perioperative risk factors, which affect outcome of patients after craniosynostosis surgery.
  
  
  METHODS
  In a retrospective study, 178 patients with craniosynostosis who underwent primary cranial reconstruction were included. Postoperative complications following neurosurgical procedures including fever in ICU, level of consciousness, re-intubation, and blood, urine, and other cultures were also performed and their association with the main outcomes (length of ICU stay) were analyzed.
  
  
  RESULTS
  Factors independently associated with a longer pediatric ICU stay were fever (OR=1.59, 95% CI=1.25-4.32;p=0.001), perioperative bleeding (OR=2.25, 95% CI=1.65-3.65;p=0.01), age (having surgery after the first 5 years) (OR=1.59, 95% CI=1.33-3.54,p=0.016) and infection (OR=2.17, 95% CI=1.83-7.46;p=0.002). Mean blood loss during surgery was significantly higher in patients whose duration of ICU was longer than 4 days compare to less than 4 day (p=0.026). Amount of bleeding significantly was correlated to duration of surgery (r=0.70,p=0.001) and patient's age (r=0.23,p=0.44).
  
  
  CONCLUSIONS
  perioperative management particularly blood loss could deteriorate patients outcome and length of stay in ICU and hospital. Infections in ICU could deteriorate outcomes.
authors.affiliation: Department of Craniomaxillofacial Surgery, Mofid Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Abdoljalil
authors.initials: A
authors.lastname: Kalantar Hormozi
authors.affiliation: Department of Pediatric Anaesthesiology, Mofid Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Nastaran
authors.initials: N
authors.lastname: Mahdavi
authors.affiliation: Department of Pediatric Anaesthesiology, Mofid Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammad Mehdi
authors.initials: MM
authors.lastname: Foroozanfar
authors.affiliation: Department of Pediatric Anaesthesiology, Mofid Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Seyed Sajad
authors.initials: SS
authors.lastname: Razavi
authors.affiliation: Department of Pediatric Anaesthesiology, Mofid Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Razavi
authors.initials: R
authors.lastname: Mohajerani
authors.affiliation: Department of Pediatric Anaesthesiology, Mofid Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Eghbali
authors.affiliation: Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Amir Ali
authors.initials: AA
authors.lastname: Mafi
authors.affiliation: Department of Craniomaxillofacial Surgery, Mofid Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Haleh
authors.initials: H
authors.lastname: Hashemzadeh
authors.affiliation: Department of Pediatric Anaesthesiology, Mofid Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Alireza
authors.initials: A
authors.lastname: Mahdavi
keywords: Craniosynostosis; Intensive care unit; Operation; Pediatric