Craniosynostosis Surgery: Does Hospital Case Volume Impact Outcomes or Cost?

Wes, Ari M.; Mazzaferro, Daniel M.; Naran, Sanjay; Hopkins, Edward; Bartlett, Scott P.; Taylor, Jesse A.

doi:10.1097/prs.0000000000003763

Cited by 23 publications

(28 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, the specific details about life-threatening and catastrophic events were not reported. 6 Our study assessed the occurrence of life-threatening and catastrophic events during the surgical treatment of patients with complex craniofacial conditions at a single high-volume pediatric craniofacial unit. Fortunately, these Fig.…”

Section: Discussionmentioning

confidence: 99%

“…There are several recently published studies detailing complications following pediatric craniosynostosis surgery. [4][5][6][7][8] In 2017, the Pediatric Craniofacial Surgery Perioperative Registry assessed 1223 cases from 31 institutions across the United States from June 2012 to September 2015 and presented a comprehensive overview of the perioperative management, outcomes, and intraoperative complications, which included cardiac arrest (0.2%), hypotension (5.3%), bradycardia requiring treatment (1.6%), suspected venous air embolism (1.1%), and large-volume (>40 mL/kg) blood transfusion (26.8.1%) but no deaths. 8 This study highlighted the large variability in perioperative management and outcomes and opportunities for improvement.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Catastrophic and Critical Intraoperative Events during Pediatric Craniofacial Surgery

Kennedy

Novak

Phillips

et al. 2023

Plastic and Reconstructive Surgery - Global Open

View full text Add to dashboard Cite

Background: Pediatric craniofacial surgery performed in tertiary care centers by dedicated teams is associated with high levels of safety and low rates of mortality. However, catastrophic and life-threatening events may occur as a result of surgical management of these complex patients. This study reviewed the incidence and acute outcomes of catastrophic and critical events during craniofacial surgery at a single high-volume center. Methods: The data reviewed included the operative procedures of two senior craniofacial surgeons over an 18-year period at a tertiary care pediatric craniofacial center. Catastrophic or critical intraoperative events were defined as events requiring the activation of an emergency code during surgery. The operative details and acute outcomes were reviewed and analyzed. Results: This study reviewed 7214 procedures performed between January 2002 and January 2019. There were 2072 (29%) cases classified as major craniofacial procedures (transcranial, mixed trans-and-extracranial, or major extracranial facial osteotomies), and code events occurred in 14 cases (0.67%; one in 148 patients): venous air embolism (n = 4), cardiac complications (n = 3), major hemorrhage (n = 3), trigeminocardiac reflex (n = 2), acute intracranial hypertension (n = 1), and acute airway obstruction (n = 1). Two cases (14%) experienced a critical event that was anesthesia-related. Cardiac arrest requiring compressions and/or defibrillation was necessary for eight patients. There were no mortalities. Surgery was curtailed in seven cases and successfully completed in seven patients. Conclusions: Catastrophic life-threatening events during pediatric craniofacial surgery are, fortunately, rare. In our institution, experienced teams in the management of catastrophic and critical intraoperative events during major pediatric craniofacial procedures resulted in no mortalities.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Catastrophic and Critical Intraoperative Events during Pediatric Craniofacial Surgery

Kennedy

Novak

Phillips

et al. 2023

Plastic and Reconstructive Surgery - Global Open

View full text Add to dashboard Cite

show abstract

“…When examining patient costs and hospital volume, this study found that patient admission charges related to orthognathic operations at high-volume hospitals were significantly less than other hospitals ( P <0.001). This trend has been seen in various general surgery and plastic surgery procedures 23–26 . However, when analyzing other craniofacial procedures, a national study on cleft palate repair was unable to demonstrate associations between hospital volume and costs 27 .…”

Section: Discussionmentioning

confidence: 99%

“…This holds true across the literature for other surgical procedures, including various general surgical procedures, cardiac surgical procedures, overall microsurgical procedures, free flap breast reconstructive surgery, craniosynostosis surgery, and orthognathic surgery. 1,[24][25][26]28 Highvolume hospitals experiencing fewer surgical complications could be because of surgeon experience, established multidisciplinary teams, and optimized care pathways for these procedures.…”

Section: Discussionmentioning

confidence: 99%

National Trends in Orthognathic Surgery: A Multi-Institutional Analysis of 6640 Patients

Kalmar

Chaker

Pontell

et al. 2023

Journal of Craniofacial Surgery

View full text Add to dashboard Cite

Background: LeFort I osteotomy (LF1) and bilateral sagittal split osteotomy (BSSO) have unique operative challenges and inherent anatomic considerations that predispose to certain adverse outcomes, yet their respective complication profiles continue to be debated given conflicting results from single-center investigations. The purpose of this study is to perform a multi-institutional analysis of complications, socioeconomic trends, and financial charges associated with orthognathic surgery. Methods: A retrospective cohort study was conducted of orthognathic procedures performed in the United States from 2010 through 2020 using the Pediatric Health Information System. Patients younger than 12 years of age were excluded. Medical complications, surgical complications, and admission costs were compared across procedures. Socioeconomic determinants and trends across regions of the country were also analyzed. Results: During the study interval, 6640 patients underwent orthognathic surgery, including LF1 (59.2%, n=3928), BSSO (14.4%, n=959), and double-jaw surgery (26.4%, n=1753). Patients undergoing LF1 were more likely to experience overall complications (P<0.001), infections (P<0.001), and blood transfusions (P<0.001) than those undergoing BSSO. High-volume hospitals were more likely to perform double-jaw procedures than other hospitals (P<0.001), yet high-volume hospitals were less likely to have surgical complications (P=0.014). Patient admission charges related to orthognathic operations at high-volume hospitals were less than other hospitals (P<0.001). Household income was higher for orthognathic procedures performed at high-volume hospitals (P<0.001). White patients were 1.5 times more likely to choose a farther, higher volume hospital for orthognathic surgery than the one locally available (P=0.041). Conclusions: LeFort I osteotomy procedures had higher infection and transfusion rates than BSSO procedures. High-volume hospitals were more likely to perform double-jaw procedures, yet high-volume hospitals had fewer complications and decreased admission charges. Future study will be needed to further elucidate case-mix index details and socioeconomic determinants of health contributing to these disparities.

show abstract

“…Nonetheless, as this subspecialty has matured, numerous advances in anesthetic and blood conservation techniques have taken place, along with many technical improvements, which have together significantly reduced associated morbidity and mortality rates. 72–78…”

mentioning

confidence: 99%