Examining the need for routine intensive care admission after surgical repair of nonsyndromic craniosynostosis: a preliminary analysis

Bonfield, Christopher M.; Basem, Jade; Cochrane, D. Douglas; Singhal, Ash; Steinbok, Paul

doi:10.3171/2018.6.peds18136

Cited by 16 publications

(16 citation statements)

References 12 publications

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“…The single-center design confers an advantage relative to other published studies, as discussed above, but it may limit the generalizability of our data to other centers, where treatment and hospitalization protocols may differ significantly, especially with regard to postoperative ICU care. Bonfield et al 5 and Wolfswinkel et al 41 ICU admission after open CVR, and elimination of ICU care may represent a significant reduction in overall hospital charges. The financial data available for our study do not specify the subgroups of charges comprising the overall hospital fee, and as such we cannot identify a single component responsible for the large difference in hospital fees between open and endoscopic treatments.…”

Section: Discussionmentioning

confidence: 99%

Cost comparison of surgical management of nonsagittal synostosis: traditional open versus endoscope-assisted techniques

Zubovic

Lapidus

Skolnick

et al. 2020

Journal of Neurosurgery: Pediatrics

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OBJECTIVEManagement of craniosynostosis at an early age is important for mitigating the risk of abnormal cranial development, but treatment can result in significant expenses. Previous research has shown that endoscope-assisted craniectomy (EAC) is less costly than open cranial vault remodeling (CVR) for patients with sagittal synostosis. The aim of this study was to strengthen the existing body of healthcare cost research by elucidating the charges associated with open and endoscopic treatment for patients with nonsagittal synostosis.METHODSThe authors performed a retrospective analysis of data obtained in 41 patients who underwent open CVR and 38 who underwent EAC with postoperative helmet therapy for nonsagittal, single-suture craniosynostosis (metopic, coronal, and lambdoid) between 2008 and 2018. All patients were < 1 year of age at the time of surgery and had a minimum 1 year of follow-up. Inpatient charges, physician fees, helmet charges, and outpatient clinic visits in the 1st year were analyzed.RESULTSThe mean ages of the children treated with EAC and open CVR were 3.5 months and 8.7 months, respectively. Patients undergoing EAC with postoperative helmet therapy required more outpatient clinic visits in the 1st year than patients undergoing CVR (4 vs 2; p < 0.001). Overall, 13% of patients in the EAC group required 1 helmet, 30% required 2 helmets, 40% required 3 helmets, and 13% required 4 or more helmets; the mean total helmeting charges were $10,072. The total charges of treatment, including inpatient charges, physician fees, outpatient clinic visit costs, and helmet charges, were significantly lower for the EAC group than they were for the open CVR group ($50,840 vs $95,588; p < 0.001).CONCLUSIONSDespite the additional charges for postoperative helmet therapy and the more frequent outpatient visits, EAC is significantly less expensive than open CVR for patients with metopic, coronal, and lambdoid craniosynostosis. In conjunction with the existing literature on clinical outcomes and perioperative resource utilization, these data support EAC as a cost-minimizing treatment for eligible patients with nonsagittal synostosis.

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Section: Discussionmentioning

confidence: 99%

Cost comparison of surgical management of nonsagittal synostosis: traditional open versus endoscope-assisted techniques

Zubovic

Lapidus

Skolnick

et al. 2020

Journal of Neurosurgery: Pediatrics

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“…Indeed, other groups have also shown that intensive care admission after the surgical repair of nonsyndromic craniosynostosis is not routinely indicated. 9 In our patient's case, the hemoglobin level obtained 1 hour postoperatively was 8.9. She was transferred to the floor and discharged on postoperative day 1.…”

Section: Minimally Invasive Strip Craniectomy For Metopic Craniosynostosis Using a Lighted Retractormentioning

confidence: 49%

Minimally invasive strip craniectomy for metopic craniosynostosis using a lighted retractor

Hersh

Lambert

Bookland

et al. 2021

Neurosurgical Focus: Video

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Surgical options for metopic craniosynostosis include the traditional open approach or a minimally invasive approach that typically involves an endoscopy-assisted strip craniectomy. The minimally invasive approach has been associated with less blood loss and operative time, a lower transfusion rate, and a shorter length of stay. Additionally, it is more cost-effective than open reconstruction, despite the need for a postoperative cranial orthosis and multiple follow-up visits. The authors describe a variation of the minimally invasive approach using a lighted retractor to perform a strip craniectomy of the metopic suture in a 2-month-old patient with metopic craniosynostosis. The video can be found here: https://vimeo.com/511237503.

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“…ICU admissions in 18 patients resulted from intraoperative issues and complications. These included vessel lacerations (5), significant blood loss (5), dural tears (4), difficult intubation or extubation (3), hypotension (3), intraoperative arrest or resuscitation (2), decreased perfusion (1), possible seizures (1), and extended time in the sphynx position (1). Several patients had constellations of related complications leading to ICU admission.…”

Section: Reasons For Icu Admissionmentioning

confidence: 99%

“…Several patients had constellations of related complications leading to ICU admission. An additional 12 ICU admissions resulted from PACU difficulties, including breathing difficulty or apnea (8), pain control issues (2), bradycardia or tachycardia (2), post-operative hemorrhage (1), facial edema (1), prolonged recovery from anesthesia (1), and possible seizures (1). Several patients had multiple PACU difficulties leading to ICU admission.…”

Section: Reasons For Icu Admissionmentioning

confidence: 99%

“…Although a plethora of studies have addressed surgical techniques for craniosynostosis, until recently few have addressed the need for postoperative ICU care after craniosynostosis surgery. [1][2][3][4][5] This study assesses the safety of our institution's floorcentered approach to postoperative care of children undergoing craniosynostosis surgery and describes our protocol for postoperative nursing care on the floor.…”

Section: Introductionmentioning

confidence: 99%

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Admission to the Regular Ward is Safe Following Uncomplicated Craniosynostosis Surgery: A Retrospective Study

Sileo

Walch

French

et al. 2021

FACE

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Background: At our craniofacial center patients are routinely admitted to a regular ward, or floor, rather an intensive care unit (ICU) after uncomplicated craniosynostosis surgery. In this study, we review the safety of our postoperative placement policy, examining the rate of transfer from floor to ICU. Methods: The charts of patients who underwent craniosynostosis surgery from 2009 through 2017 at a single children’s hospital were reviewed. Postoperative hospital courses were characterized as preoperatively-planned ICU admission, perioperatively-planned ICU admission, or primary floor admission. The primary outcome was transfer from floor to ICU. Secondary outcomes included duration of hospitalization. Results: Chart review yielded 420 patients. Three hundred sixty-eight (88%) were admitted directly to the floor and 52 (12.0%) directly to an ICU. Of patients admitted to the floor, 2 (0.5%) were transferred to an ICU. Twenty-four patients with syndromic and 20 patients with multisutural craniosynostosis were admitted to the floor. Only 1 patient from each group (the same patient; 4.2% and 5.0%, respectively), was transferred to an ICU. Thirty-two ICU admissions were preoperatively planned and 20 were perioperatively planned. Reasons for preoperatively planned ICU admission included significant comorbidities and type of surgery. Reasons for perioperatively planned ICU admissions included significant intraoperative adverse events, excessive blood loss, and failure of clearance from the post-anesthesia care unit (PACU). Patients admitted to the ICU had a statistically significant longer mean length of hospitalization (4.8 days vs 2.7 days) than did patients admitted to the floor. Conclusions: Most postoperative craniosynostosis surgery patients—including patients with syndromic and/or multisutural synostosis—are managed safely on the floor at our center. Some patients still need postoperative ICU admission, but are easily identified preoperatively, intraoperatively, or in the PACU. Our findings should be applicable to other large craniofacial centers.

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Examining the need for routine intensive care admission after surgical repair of nonsyndromic craniosynostosis: a preliminary analysis

Cited by 16 publications

References 12 publications

Cost comparison of surgical management of nonsagittal synostosis: traditional open versus endoscope-assisted techniques

Cost comparison of surgical management of nonsagittal synostosis: traditional open versus endoscope-assisted techniques

Minimally invasive strip craniectomy for metopic craniosynostosis using a lighted retractor

Admission to the Regular Ward is Safe Following Uncomplicated Craniosynostosis Surgery: A Retrospective Study

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