title: A proposal for a new classification of complications in craniosynostosis surgery.
abstract: OBJECTIVE Complications have been used extensively to facilitate evaluation of craniosynostosis practice. However, description of complications tends to be nonstandardized, making comparison difficult. The authors propose a new pragmatic classification of complications that relies on prospective data collection, is geared to capture significant morbidity as well as any "near misses" in a systematic fashion, and can be used as a quality improvement tool. METHODS Data on complications for all patients undergoing surgery for nonsyndromic craniosynostosis between 2010 and 2015 were collected from a prospective craniofacial audit database maintained at the authors' institution. Information on comorbidities, details of surgery, and follow-up was extracted from medical records, anesthetic and operation charts, and electronic databases. Complications were defined as any unexpected event that resulted or could have resulted in a temporary or permanent damage to the child. RESULTS A total of 108 operations for the treatment of nonsyndromic craniosynostosis were performed in 103 patients during the 5-year study period. Complications were divided into 6 types: 0) perioperative occurrences; 1) inpatient complications; 2) outpatient complications not requiring readmission; 3) complications requiring readmission; 4) unexpected long-term deficit; and 5) mortality. These types were further subdivided according to the length of stay and time after discharge. The overall complication rate was found to be 35.9%. CONCLUSIONS The proportion of children with some sort of complication using the proposed definition was much higher than commonly reported, predominantly due to the inclusion of problems often dismissed as minor. The authors believe that these complications should be included in determining complication rates, as they will cause distress to families and may point to potential areas for improving a surgical service.
authors.affiliation: Departments of 1 Neurosurgery.
authors.forename: Dmitri
authors.initials: D
authors.lastname: Shastin
authors.affiliation: Departments of 1 Neurosurgery.
authors.forename: Sharron
authors.initials: S
authors.lastname: Peacock
authors.affiliation: Anaesthetics, Leeds General Infirmary; and.
authors.forename: Velu
authors.initials: V
authors.lastname: Guruswamy
authors.affiliation: School of Medicine, University of Leeds, United Kingdom.
authors.forename: Melpo
authors.initials: M
authors.lastname: Kapetanstrataki
authors.affiliation: School of Medicine, University of Leeds, United Kingdom.
authors.forename: David T
authors.initials: DT
authors.lastname: Bonthron
authors.affiliation: Plastic and Reconstructive Surgery.
authors.forename: Maggie
authors.initials: M
authors.lastname: Bellew
authors.affiliation: Ophthalmology, and.
authors.forename: Vernon
authors.initials: V
authors.lastname: Long
authors.affiliation: Maxillofacial Surgery.
authors.forename: Lachlan
authors.initials: L
authors.lastname: Carter
authors.affiliation: Plastic and Reconstructive Surgery.
authors.forename: Ian
authors.initials: I
authors.lastname: Smith
authors.affiliation: Departments of 1 Neurosurgery.
authors.forename: John
authors.initials: J
authors.lastname: Goodden
authors.affiliation: Maxillofacial Surgery.
authors.forename: John
authors.initials: J
authors.lastname: Russell
authors.affiliation: Plastic and Reconstructive Surgery.
authors.forename: Mark
authors.initials: M
authors.lastname: Liddington
authors.affiliation: Departments of 1 Neurosurgery.
authors.forename: Paul
authors.initials: P
authors.lastname: Chumas
mesh_terms: D002675:Child, Preschool; D015897:Comorbidity; D003398:Craniosynostoses / Q000453:epidemiology / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000706:statistics & numerical data; D010359:Patient Readmission; D011183:Postoperative Complications / Q000145:classification* / Q000453:epidemiology; D011446:Prospective Studies; D012189:Retrospective Studies
keywords: ACS = American College of Surgeons; FOAR = frontoorbital advancement and remodeling; ICP = intracranial pressure; LOS = length of stay; MACR = major calvarial reconstruction; MICR = minor calvarial reconstruction; NSQIP = National Surgical Quality Improvement Program; SD = standard deviation; audit; complications; craniofacial; craniosynostosis; morbidity; outcome