Endoscopic Versus Open Repair for Craniosynostosis in Infants Using Propensity Score Matching to Compare Outcomes: A Multicenter Study from the Pediatric Craniofacial Collaborative Group

Thompson, Douglas; Zurakowski, David; Haberkern, Charles M.; Stricker, Paul A.; Meier, Petra M.; Bannister, Carolyn F.; Benzon, Hubert A.; Binstock, Wendy; Bosenberg, Adrian; Brzenski, Alyssa; Budac, Stefan; Busso, Veronica; Capehart, Samantha; Chiao, Franklin; Cladis, Franklyn P.; Collins, Michael; Cusick, Jordan; Dabek, Rachel; Dalesio, Nicholas M.; Falcon, Ricardo; Fernández, Allison M.; Fernandez, Patrick; Fiadjoe, John E.; Gangadharan, Meera; Gentry, Katherine R.; Glover, Chris D.; Goobie, Susan M.; Gries, Heike; Griffin, Allison; Groenewald, Cornelius B.; Hajduk, John; Hall, Rebecca; Hansen, Jennifer; Hetmaniuk, Mali; Hsieh, Vincent; Huang, Henry; Ingelmo, Pablo; Ivanova, Iskra; Jain, Ranu; Koh, Jeffrey L.; Kowalczyk‐Derderian, Courtney; Kugler, Jane; Labovsky, Kristen; Martínez, José Luis; Mujallid, Razaz; Muldowney, Bridget L.; Nguyen, Kim‐Phuong; Nguyen, Thanh T.; Olutuye, Olutoyin; Soneru, Codruta; Petersen, Timothy R.; Poteet‐Schwartz, Kim; Reddy, Srijaya K.; Reid, Russell R.; Ricketts, Karene; Rubens, Daniel; Skitt, Rochelle; Sohn, Lisa; Staudt, Susan R.; Sung, Wai; Syed, Tariq; Szmuk, Peter; Taicher, Brad M.; Tetreault, Lisa; Watts, Rheana; Wong, Karen; Young, Vanessa; Zamora, Lillian

doi:10.1213/ane.0000000000002454

Cited by 56 publications

(49 citation statements)

References 21 publications

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“…1 ). Our 2018 transfusion rate of 22.7% is comparable to the transfusion rate of 26% found by Thompson et al 12 in their review of endoscopic craniosynostosis repair, which is associated with significantly less blood loss than open cranial vault repair. The PCCG reported a multicenter observational study of a perioperative transfusion rate of 95% in children less 24 months of age undergoing craniosynostosis repair.…”

Section: Discussionsupporting

confidence: 77%

The Road to Transfusion-free Craniosynostosis Repair in Children Less Than 24 Months Old: A Quality Improvement Initiative

Beethe

Spitznagel

Kugler³

et al. 2020

Pediatric Quality &Amp; Safety

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Introduction: Pediatric craniofacial reconstruction has historically resulted in extensive blood loss necessitating transfusion. This single-center quality improvement initiative evaluates the impact of perioperative practice changes on the allogeneic transfusion rate for children 24 months and younger of age undergoing craniofacial reconstruction. Methods: At project initiation, an appointed core group of anesthesiologists provided all intraoperative anesthetic care for patients undergoing craniofacial reconstruction. Standardized anesthetic guidelines established consistency between providers. Using the Plan-do-check-act methodology, practice changes had been implemented and studied over a 5-year period. Improvement initiatives included developing a temperature-management protocol, using a postoperative transfusion protocol, administering intraoperative tranexamic acid, and a preincisional injection of 0.25% lidocaine with epinephrine. For each year of the project, we acquired data for intraoperative and postoperative allogeneic transfusion rates. Results: A cohort of 119 pediatric patients, ages 4–24 months, underwent anterior or posterior vault reconstruction for craniosynostosis at a tertiary children’s hospital between March 2013 and November 2018. Intraoperative and postoperative transfusion of allogeneic blood products in this cohort decreased from 100% preintervention to 22.7% postintervention. Conclusions: Interdepartmental collaboration and practice modifications using sequential Plan-do-check-act cycles resulted in a bundle of care that leads to a sustainable decrease in the rate of intraoperative and postoperative allogeneic blood transfusions in patients less than 24 months of age undergoing craniosynostosis repair. This bundle decreases the risk of transfusion-related morbidity for these patients. Other institutions looking to achieve similar outcomes can implement this project.

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Section: Discussionsupporting

confidence: 77%

The Road to Transfusion-free Craniosynostosis Repair in Children Less Than 24 Months Old: A Quality Improvement Initiative

Beethe

Spitznagel

Kugler³

et al. 2020

Pediatric Quality &Amp; Safety

View full text Add to dashboard Cite

show abstract

“…Consistent with studies of large patient series published by high-volume centers, both treatment options have an acceptable risk profile. 3,8,15,30,32,36 However, ES is uniformly associated with lower perioperative morbidity. 15,18,19,27,32,36 Orthotic noncompliance infrequently occurred and did not result in a need for reoperation.…”

Section: Perioperative Outcomesmentioning

confidence: 99%

Analysis of clinical outcomes for treatment of sagittal craniosynostosis: a comparison of endoscopic suturectomy and cranial vault remodeling

Isaac¹,

Meara²,

Proctor

2018

Journal of Neurosurgery: Pediatrics

104

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OBJECTIVEComparative effectiveness studies are needed for analyzing the clinical outcomes of treatment of sagittal craniosynostosis (SC) with endoscopic suturectomy (ES) or cranial vault remodeling (CVR).METHODSFrom 2004–2015, patients were consecutively reviewed and data recorded for operative details and complications. Cranial growth was measured by head circumference percentile (HCP) and cranial index (CI) Z-score. Aesthetic outcomes were compared using the Whitaker classification.RESULTSA total of 207 patients with nonsyndromic SC were treated with ES (n = 187) or CVR (n = 20). The ES group had a lower median operative duration (45 vs 195 minutes), length of stay (1 vs 3 days), and transfusion rate (2% vs 85%; p < 0.0001). Median age at follow-up was 3.0 years (interquartile range [IQR] 2.5–4.5, ES) and 3.9 years (IQR 2–5, CVR; p = 0.12). In both groups, HCP gradually decreased during a 3-year follow-up (p = 0.282). CI Z-scores were initially more favorable in the ES group (p < 0.05); 3 years following surgical intervention, Z-scores were equal between groups (p = 0.392). One nonsyndromic patient treated with ES (0.5%) demonstrated reossification and required secondary expansion. Most patients were Whitaker class I (99% of ES, 95% of CVR); 5% of CVR patients were class II and 1% of ES patients were class III. Four syndromic patients presented without clear evidence of a syndrome, were treated by ES, and subsequently required secondary expansion for raised intracranial pressure.CONCLUSIONSES is an effective treatment for nonsyndromic SC with comparable head growth, aesthetic outcomes, and less morbidity relative to CVR. In the absence of a syndrome, secondary cranial expansion following ES is rarely required.

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“…Endoscopic techniques in craniofacial surgery are being increasingly utilized due to good outcomes, lower morbidity, costs, blood loss, and equivalent or superior aesthetic outcomes. As demonstrated by Thompson et al [46], endoscopic treatment utilizes less blood (26% vs. 81%, p < 0.001), coagulation products (3% vs. 16%, p < 0.001), anesthesia (168 vs. 248 min %, p < 0.001), surgical duration (70 vs. 130 min %, p < 0.001), days in ICU (0 vs. 2%, p < 0.001), and hospital LOS (2 vs. 4%, p < 0.001) [46]. However, if a child is not seen within an appropriate timeframe, endoscopic craniosynostosis repair is no longer possible.…”

Section: Craniosynostosis-single Suture Non-syndromic Synostosismentioning

confidence: 79%

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

et al. 2020

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SARS-CoV-2 COVID-19, coronavirus, has created unique challenges for the medical community after national guidelines called for the cancellation of all elective surgery. While there are clear cases of elective surgery (benign cranial cosmetic defect) and emergency surgery (hemorrhage, fracture, trauma, etc.), there is an unchartered middle ground in pediatric neurosurgery. Children, unlike adults, have dynamic anatomy and are still developing neural networks. Delaying seemingly elective surgery can affect a child's already vulnerable health state by further impacting their neurocognitive development, neurologic functioning, and potential long-term health states. The purpose of this paper is to demonstrate that "elective" pediatric neurosurgery should be risk-stratified, and multi-institutional informed guidelines established.

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Endoscopic Versus Open Repair for Craniosynostosis in Infants Using Propensity Score Matching to Compare Outcomes: A Multicenter Study from the Pediatric Craniofacial Collaborative Group

Abstract: This multicenter study of ESC versus open craniosynostosis repair represents the largest comparison to date. It demonstrates striking advantages of ESC for young infants that may result in improved clinical outcomes, as well as increased safety.

Cited by 56 publications

References 21 publications

The Road to Transfusion-free Craniosynostosis Repair in Children Less Than 24 Months Old: A Quality Improvement Initiative

The Road to Transfusion-free Craniosynostosis Repair in Children Less Than 24 Months Old: A Quality Improvement Initiative

Analysis of clinical outcomes for treatment of sagittal craniosynostosis: a comparison of endoscopic suturectomy and cranial vault remodeling

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

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