Abraham Peter, Brandel Michael G, Dalle Ore Cecilia L, Reid Chris M, Kpaduwa Chinwe S, Lance Samuel, Meltzer Hal S, Gosman Amanda A
Ann Plast Surg. 2018 May;80(5S Suppl 5):S261-S266. doi: 10.1097/SAP.0000000000001383.
Timing of intervention and complication profiles in surgical repair of craniosynostosis have been widely debated. Early intervention is frequently promoted as a means of decreasing morbidity while maintaining favorable outcomes via minimally invasive techniques such as endoscopic strip craniectomy. Immediate postoperative morbidity due to complications of early vs late intervention remains a key element in comparing timing and technique for craniosynostosis repair. In addition, concurrent fronto-orbital advancement with open cranial vault remodeling may increase the risk of postoperative complications. We present an evaluation of surgical timing and the presence of fronto-orbital advancement as independent predictors of in-hospital complications after craniosynostosis repair.
Retrospective analysis was performed in the National Inpatient Sample database from 1998 to 2009. Patients younger than 3 years having undergone elective surgical repair for craniosynostosis were identified. Comorbidities, demographics, transfusion status, and syndromic diagnosis were included as covariates. A multivariate regression model was used to characterize the association between age at the time of surgery and in-hospital complications. A subgroup analysis using the variable of concurrent fronto-orbital advancement was restricted to patients 8 to 24 months of age to exclude endoscopic craniosynostosis repair, which is traditionally repaired less than 6 months of age. Multivariate logistic regression was used to assess the impact of concurrent fronto-orbital advancement on postoperative complications.
A total of 6010 craniosynostosis surgery cases (42.9%, age 0-7 months; 29.5%, age 8-12 months; and 27.6%, age 13-36 months) were included. Patients in the 7-to 12-month age group were more likely to experience complications when compared with the 0- to 6-month age group (odds ratio [OR],1.32; P < 0.05) and 13-to 36-month age group (OR, 1.32; P = 0.056). Syndromic patients (OR, 1.92; P < 0.001) and patients receiving an intraoperative blood transfusion (OR, 1.60; P < 0.05) demonstrated an increased risk for complications. In the subanalysis of 2936 patients aged 8 to 24 months, 15.1% of patients received frontoorbital advancement, which was associated with a significantly increased risk of complications (OR, 1.43; P < 0.05).
Intermediate age (7-12 months) and concurrent fronto-orbital repair were independent risk factors for immediate postoperative complications. These findings may better inform the decision-making process for craniosynostosis repair in terms of timing and need for concurrent fronto-orbital reconstruction.
颅骨缝早闭手术修复的干预时机和并发症情况一直存在广泛争议。早期干预常被提倡作为一种降低发病率的手段，同时通过诸如内镜下条带颅骨切除术等微创技术维持良好的治疗效果。早期与晚期干预并发症导致的术后即时发病率仍是比较颅骨缝早闭修复时机和技术的关键因素。此外，同期进行额眶前移与开放性颅穹窿重塑可能会增加术后并发症的风险。我们对手术时机以及额眶前移的存在作为颅骨缝早闭修复术后院内并发症的独立预测因素进行了评估。
对1998年至2009年国家住院患者样本数据库进行回顾性分析。确定年龄小于3岁且接受颅骨缝早闭择期手术修复的患者。将合并症、人口统计学特征、输血情况和综合征诊断作为协变量纳入。使用多变量回归模型来描述手术时年龄与院内并发症之间的关联。使用同期额眶前移变量进行的亚组分析仅限于8至24个月龄的患者，以排除传统上在6个月龄以下进行修复的内镜下颅骨缝早闭修复术。使用多变量逻辑回归评估同期额眶前移对术后并发症的影响。
共纳入6010例颅骨缝早闭手术病例（42.9%，年龄0至7个月；29.5%，年龄8至12个月；27.6%，年龄13至36个月）。与0至6个月龄组（优势比[OR]，1.32；P<0.05）和13至36个月龄组（OR，1.32；P = 0.056）相比，7至12个月龄组的患者更易发生并发症。综合征患者（OR，1.92；P<0.001）和术中接受输血的患者（OR，1.60；P<0.05）并发症风险增加。在对2936例8至24个月龄患者的亚分析中，15.1%的患者接受了额眶前移，这与并发症风险显著增加相关（OR，1.43；P<0.05）。
中等年龄（7至12个月）和同期额眶修复是术后即时并发症的独立危险因素。这些发现可能会在颅骨缝早闭修复的时机选择和同期额眶重建需求方面为决策过程提供更好的参考。
