Secondary Corrections for Single-Suture Craniosynostosis: Perioperative Outcomes and Predisposing Factors

Abstract

Background: Many single-suture craniosynostosis corrections end up needing secondary remodeling procedures. The authors sought to determine whether these more complicated operations carry higher complication rates, and to explore potential predisposing factors. Methods: The authors performed a retrospective chart review of all patients undergoing primary and secondary remodeling corrections at a single center, between 2010 and 2020. Results: Of 491 sequential single-suture corrections, 380 were primary procedures and 111 were secondary (89.2% initially treated elsewhere); 10.3% of primary procedures received allogeneic blood versus only 1.8% of secondary corrections (p =0.005). Median hospital lengths of stays were similar between groups [primary, 2.0 days (interquartile range [IQR], 2 to 2); secondary, 2.0 days (IQR, 2 to 2)], as were surgical infection rates (primary, 0%; secondary, 0.9%). With respect to predisposing factors, the affected suture and presence of a genetic mutation did not appear predictive; however, the median age at primary correction was significantly younger for those needing second procedures [6.0 months (IQR, 4 to 9 months) versus 12.0 months (IQR, 11 to 16 months)]. An odds ratio estimate suggests that for every month increase in age, the odds of undergoing a reoperation drops 40%. With respect to surgical indications, concerns for raised intracranial pressure and skull defects were more commonly cited following strip craniectomies than remodeling procedures. Conclusions: This single-center review was unable to identify a higher risk profile for reoperations. In addition, analyses suggest that performing primary corrections at a younger age and, possibly, strip craniectomies were associated with a higher likelihood of a subsequent secondary correction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Discussion: Secondary Corrections for Single-Suture Craniosynostosis: Perioperative Outcomes and Predisposing Factors

“…A s we continue to look more critically at the long-term outcomes after cranial vault remodeling, the topic of secondary (or revision) surgery has appropriately gained popularity. 1 Treatment algorithms for craniosynostosis are far from standardized and remain subject to passionate debate regarding type and timing of surgery. A lack of standardized reporting and outcome metrics further compounds the issue.…”