Bartz-Kurycki Marisa, Wei Shuyan, Bernardi Karla, Moffitt Joseph K, Greives Matthew R
Department of Pediatric Surgery.
Department of General Surgery.
J Craniofac Surg. 2019 Mar/Apr;30(2):442-447. doi: 10.1097/SCS.0000000000005114.
Congenital cardiac malformations have been reported in 8% of patients with craniosynostosis undergoing cranial vault remodeling (CVR), but associations with surgical outcomes are unknown. This study evaluated postoperative complications in patients who underwent CVR for craniosynostosis with or without cardiac risk factors (CRF) using the National Safety Quality Improvement Program-Pediatric (NSQIP-P) database. NSQIP-P database was queried for patients <2 years with craniosynostosis who underwent CVR from 2012 to 2016 based on diagnosis and procedure codes. The primary outcome was a composite of available NSQIP-P complications. Analysis compared patients with craniosynostosis based on the presence or absence of CRF. Univariate and multiple logistic regression identified risk factors associated with postoperative complications. A total of 3293 patients met inclusion criteria (8% with CRF). Two-thirds of patients experienced at least 1 complication, though patients with CRF experienced a greater proportion (74% vs 66%, P = 0.001). Univariate analysis identified associations between post-operative complications and age, ASA class, supplemental oxygen, neuromuscular disorders, preoperative nutritional supplementation, interventricular hemorrhage, and CRF. On multivariate regression, only older age (OR 1.17, 95% CI 1.01-1.36) and longer operative duration (OR 1.01, 95% CI 1.01-1.01) were associated with greater odds of postoperative complications. The most common complication in patients with craniosynostosis who undergo CVR is bleeding requiring transfusion. Older age and longer operative duration were associated with postoperative complications. Although patients with CRF have more postoperative complications, CRF was not a risk factor on adjusted analysis.
据报道，在接受颅骨重塑（CVR）的颅缝早闭患者中，8%存在先天性心脏畸形，但与手术结果的关联尚不清楚。本研究使用国家质量改进计划-儿科（NSQIP-P）数据库评估了因颅缝早闭接受CVR且有或无心脏危险因素（CRF）的患者的术后并发症。根据诊断和手术编码，在NSQIP-P数据库中查询2012年至2016年接受CVR的2岁以下颅缝早闭患者。主要结局是可用的NSQIP-P并发症的综合情况。分析比较了有或无CRF的颅缝早闭患者。单因素和多因素逻辑回归确定了与术后并发症相关的危险因素。共有3293例患者符合纳入标准（8%有CRF）。三分之二的患者至少经历了1种并发症，不过有CRF的患者经历并发症的比例更高（74%对66%，P = 0.001）。单因素分析确定了术后并发症与年龄、美国麻醉医师协会（ASA）分级、补充氧气、神经肌肉疾病、术前营养补充、脑室内出血和CRF之间的关联。多因素回归分析显示，只有年龄较大（比值比[OR]1.17，95%置信区间[CI]1.01 - 1.36）和手术时间较长（OR 1.01，95% CI 1.01 - 1.01）与术后并发症的发生几率较高相关。接受CVR的颅缝早闭患者最常见的并发症是需要输血的出血。年龄较大和手术时间较长与术后并发症相关。虽然有CRF的患者术后并发症更多，但在调整分析中CRF不是危险因素。
