Routine Postoperative Admission to the Intensive Care Unit Following Repair of Nonsyndromic Craniosynostosis: Is it Necessary?

Abstract

Background: Cranial vault surgery for craniosynostosis is generally managed postoperatively in the intensive care unit (ICU). The purpose of the present study was to examine our center's experience with the postoperative management of otherwise healthy patients with nonsyndromic craniosynostosis (NSC) without routine ICU admission. Methods: A retrospective cohort study of patients with NSC operated using a variety of vault reshaping techniques in our pediatric center between 2009 and 2017 was carried out. Patients with documented preexisting comorbidities that would have required admission to the ICU regardless of the surgical intervention were excluded. Results: A total of 102 patients were included in the study. Postoperatively, 100 patients (98%) were admitted as planned to a general surgical ward following observation in the recovery room. Two patients (2%) required ICU admission due to adverse intraoperative events. There were no patients who required transfer to the ICU from the recovery area or surgical ward. Within the surgical ward cohort, 6 patients (6%) had minor postoperative complications that were readily managed on the surgical floor. Postoperative anemia requiring transfusion was the most common complication. Conclusion: The results from this study suggest that otherwise healthy patients with NSC undergoing cranial vault surgery can potentially be safely managed without routine admission to the ICU postoperatively. Key elements are proper preoperative screening, access to ICU should an adverse intraoperative event occur and necessary postoperative surgical care. The authors hope that this experience will encourage other craniofacial surgeons to reconsider the dogma of routine ICU admission for this patient population.

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

“…1 Chocron et al found that in 102 nonsyndromic cranial vault surgery cases, otherwise healthy patients could safely bypass ICU admission. 2 Seruya et al found that none of the 95% of 107 patients who were admitted to the surgical floor after frontoorbital advancement needed ICU transfer, 4 while Wolfwinkel et al found that none of the 89% of 105 children who were admitted to the floor after surgery for sagittal synostosis needed ICU transfer. 5 Despite this evidence, many craniosynostosis patients are still admitted to an ICU after surgery.…”

“…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.…”

Simplified Postoperative Care After Spring-assisted Strip Craniotomy for Sagittal Synostosis: A Prospective Before-and-After Study

“…Therefore, continuous infusion of morphine has been an advocated and reportedly safe alternative for postoperative analgesia. 15,16 However, in the absence of potentially deleterious side effects associated with an inadvertently high morphine-infusion rate, the already questioned 7,8,17 need for monitoring in the ICU diminishes. In a future, further simplified postoperative protocol, our use of i.v.…”

“…The monitoring protocols applied have been extensive in order to allow judicious pain control by appropriately addressing side effects and detecting any adverse intracranial events that would necessitate reoperation. However, recent reports suggest that postoperative nursing of otherwise healthy patients operated for craniosynostosis can safely be leveled down from the ICU to a traditional ward 7,8 . In a previous study, we showed that complication rates after surgery for craniosynostosis were considerably milder in less extensive surgery as compared with those associated with more extensive surgery, and that SAS for sagittal synostosis has a particularly beneficial complication pattern with very few reoperations during the index admission 9 .…”

“…However, recent reports suggest that postoperative nursing of otherwise healthy patients operated for craniosynostosis can safely be leveled down from the ICU to a traditional ward. 7,8 In a previous study, we showed that complication rates after surgery for craniosynostosis were considerably milder in less extensive surgery as compared with those associated with more extensive surgery, and that SAS for sagittal synostosis has a particularly beneficial complication pattern with very few reoperations during the index admission. 9 In view of this and current literature, a simplification of postoperative care procedures for less extensive craniofacial repair should be feasible.…”