Age at Time of Craniosynostosis Repair Predicts Increased Complication Rate

Abstract

Craniosynostosis repair is safe; however, the risk of complications increases with age at intervention. Presence of a syndromic congenital deformity at any age carries the greatest increased risk of perioperative complications. This suggests that optimal timing of intervention is within the first year of life, especially in those cases with additional factors increasing perioperative risk. These data support the importance of counseling patients of the increased risk associated with delaying craniosynostosis repair.

A Summary of Recommendations for Plastic Surgeons during the Coronavirus Disease 2019 Outbreak

“… 62 , 63 Patients who are not candidates for minimally invasive options, open cranial vault remodeling is favored before the age of 12 months as re-ossification potential decreases after the age of 1 year and complication rates increase. 64 , 65 Patients presenting with symptoms of elevated intracranial pressure are classified as Tier 3a; intervention should not be postponed.…”

Considerations for Pediatric Craniofacial Surgeons During the COVID-19 Outbreak

“…For patients who are outside of the window for minimally invasive procedures, intervention for open cranial vault remodeling remains time sensitive as patients who undergo the procedure over 12 months of age can have decreased rates of reossification and higher complication rates. 27,28 Based on the CMS classification, these patients are classified as Tier 2a; however, due to the risk of complications and decreased reossification rates, open cranial vault remodeling is ideally performed prior to 12 months of age. In situations where patients present with findings of elevated intracranial pressure, acute intervention is required and these patients are classified as Tier 3a; this intervention should not be postponed.…”

The impact of imposed delay in elective pediatric neurosurgery: an informed hierarchy of need in the time of mass casualty crisis

“…A retrospective study spanning 6 years, 44 states, and 8417 children under the age of 3 was conducted by Bruce et al [47] to determine the optimal time to surgically repair craniosynostosis. Using the Healthcare Cost and Utilization Project Kids' inpatient database (KID), the overall complication rate was 8.6%: 6.6% for children aged 0 to 6 months, 10.3% for patients aged 7 to 12 months, and 13.9% in children aged 12 to 36 months [47].…”

“…A retrospective study spanning 6 years, 44 states, and 8417 children under the age of 3 was conducted by Bruce et al [47] to determine the optimal time to surgically repair craniosynostosis. Using the Healthcare Cost and Utilization Project Kids' inpatient database (KID), the overall complication rate was 8.6%: 6.6% for children aged 0 to 6 months, 10.3% for patients aged 7 to 12 months, and 13.9% in children aged 12 to 36 months [47]. Additionally, a multivariable logistic regression model to identify factors that increase perioperative surgical complication demonstrated age as a significant factor (OR = 2.53 at 3 years vs. < 1, 95% CI 1.67-3.82) [47].…”

“…Using the Healthcare Cost and Utilization Project Kids' inpatient database (KID), the overall complication rate was 8.6%: 6.6% for children aged 0 to 6 months, 10.3% for patients aged 7 to 12 months, and 13.9% in children aged 12 to 36 months [47]. Additionally, a multivariable logistic regression model to identify factors that increase perioperative surgical complication demonstrated age as a significant factor (OR = 2.53 at 3 years vs. < 1, 95% CI 1.67-3.82) [47]. Another study using the KID database showed delayed repair of craniosynostosis to be associated with longer length of stay (LOS) and increased cost [48].…”