Massenburg Benjamin B, Nassar Amer H, Hopper Richard A
Division of Plastic Surgery, Department of Surgery, University of Washington.
Division of Plastic and Craniofacial Surgery, Craniofacial Center, Seattle Children's Hospital.
J Craniofac Surg. 2020 Jan/Feb;31(1):154-157. doi: 10.1097/SCS.0000000000006067.
While there has been ample interest and literature published regarding craniosynostosis surgical technique, there are few reports on adverse hospital and health system outcomes. The purpose of this study was to describe rate of and risk factors for complications, and adverse outcomes following craniosynostosis reconstruction.
This study retrospectively reviewed the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Pediatric database and identified all patients undergoing craniosynostosis repair from 2012 to 2016. Univariate logistic regression analysis was used to identify significant associations between preoperative risk factors and adverse outcomes. Multivariate logistic regression analysis was then used to identify independent risk factors and causes of prolonged operative times, transfusions, reoperation, prolonged length of hospital stays, and readmission.
There were 3924 patients included who underwent craniosynostosis repair, of whom 1732 underwent frontoorbital advancement and 2192 underwent cranial vault remodeling. Transfusion was the most common NSQIP reportable outcome, occurring for 66.5% of all patients. The incidence of reoperation was 2.4% and readmission was 3.0%.
This study provides a large descriptive analysis of craniosynostosis repair throughout the United States. Largely nonmodifiable patient risk factors lead to worse health system metrics, with young age, gastrointestinal comorbidities, American Society of Anesthesiologist scores of 3 and greater, reoperation, and a prolonged length of stay as independent risk factors for readmission. This analysis can be used to identify the standard of practice in synostosis care and enhance the implementation of ancillary care services to provide safe and cost-effective care for patients undergoing craniosynostosis repair.
虽然关于颅缝早闭手术技术已有大量研究兴趣并发表了相关文献，但关于不良医院及卫生系统结局的报道却很少。本研究的目的是描述颅缝早闭重建术后并发症的发生率及危险因素，以及不良结局。
本研究回顾性分析了美国外科医师学会国家外科质量改进计划（NSQIP）儿科数据库，确定了2012年至2016年期间所有接受颅缝早闭修复手术的患者。采用单因素逻辑回归分析确定术前危险因素与不良结局之间的显著关联。然后使用多因素逻辑回归分析确定延长手术时间、输血、再次手术、延长住院时间和再次入院的独立危险因素及原因。
共有3924例患者接受了颅缝早闭修复手术，其中1732例行额眶前移术，2192例行颅骨重塑术。输血是NSQIP中最常见的可报告结局，所有患者中的发生率为66.5%。再次手术发生率为2.4%，再次入院率为3.0%。
本研究对美国各地的颅缝早闭修复手术进行了大规模描述性分析。很大程度上不可改变的患者危险因素会导致更差的卫生系统指标，年龄小、胃肠道合并症、美国麻醉医师协会评分为3分及以上、再次手术以及住院时间延长是再次入院的独立危险因素。该分析可用于确定颅缝早闭治疗的实践标准，并加强辅助护理服务的实施，为接受颅缝早闭修复手术的患者提供安全且具有成本效益的护理。
