Predictors of perioperative complications in paediatric cranial vault reconstruction surgery: a multicentre observational study from the Pediatric Craniofacial Collaborative Group

S M Goobie; D Zurakowski; K V Isaac; B M Taicher; P G Fernandez; C K Derderian; M Hetmaniuk; P A Stricker; Pediatric Craniofacial Collaborative Group

doi:10.1016/j.bja.2018.10.061

Predictors of perioperative complications in paediatric cranial vault reconstruction surgery: a multicentre observational study from the Pediatric Craniofacial Collaborative Group

Br J Anaesth. 2019 Feb;122(2):215-223. doi: 10.1016/j.bja.2018.10.061. Epub 2018 Dec 19.

Authors

S M Goobie¹, D Zurakowski², K V Isaac³, B M Taicher⁴, P G Fernandez⁵, C K Derderian⁶, M Hetmaniuk⁷, P A Stricker⁸; Pediatric Craniofacial Collaborative Group

Collaborators

Pediatric Craniofacial Collaborative Group:
Christopher Abruzzese, Jesus Apuya, Amy Beethe, Hubert Benzon, Wendy Binstock, Alyssa Brzenski, Stefan Budac, Veronica Busso, Surendrasingh Chhabada, Franklin Chiao, Franklyn Cladis, Danielle Claypool, Michael Collins, Rachel Dabek, Nicholas Dalesio, Ricardo Falconl, Allison Fernandez, Patrick Fernandez, John Fiadjoe, Meera Gangadharan, Katherine Gentry, Chris Glover, Susan M Goobie, Amanda Gosman, Shannon Grap, Heike Gries, Allison Griffin, Charles Haberkern, John Hajduk, Rebecca Hall, Jennifer Hansen, Mali Hetmaniuk, Vincent Hsieh, Henry Huang, Pablo Ingelmo, Iskra Ivanova, Ranu Jain, Michelle Kars, Courtney Kowalczyk-Derderian, Jane Kugler, Kristen Labovsky, Indrani Lakheeram, Andrew Lee, Jose Luis Martinez, Brian Masel, Eduardo Medellin, Petra Meier, Heather Mitzel Levy, Wallis T Muhly, Bridget Muldowney, Jonathon Nelson, Julie Nicholson, Kim-Phuong Nguyen, Thanh Nguyen, Olutoyin Olutuye, Margaret Owens-Stubblefield, Uma Ramesh Parekh, Timothy Petersen, Vanessa Pohl, Julian Post, Kim Poteet-Schwartz, Jansie Prozesky, Srijaya Reddy, Russell Reid, Karene Ricketts, Daniel Rubens, Laura Ryan, Rochelle Skitt, Codruta Soneru, Rachel Spitznagel, Paul Stricker, Davinder Singh, Neil R Singhal, Emad Sorial, Susan Staudt, Bobbie Stubbeman, Wai Sung, Tariq Syed, Peter Szmuk, Brad M Taicher, Douglas Thompson, Lisa Tretault, Galit Ungar-Kastner, Rheana Watts, John Wieser, Karen Wong, Lillian Zamora

Affiliations

¹ Harvard Medical School, Boston, MA, USA; Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA. Electronic address: susan.goobie@childrens.harvard.edu.
² Harvard Medical School, Boston, MA, USA; Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.
³ Division of Plastic and Reconstructive Surgery, University of British Columbia, Vancouver, BC, Canada.
⁴ Duke University Medical Center, Durham, NC, USA; Department of Anesthesiology, Duke Children's Hospital, Durham, NC, USA.
⁵ Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA; Children's Hospital Colorado, Aurora, CO, USA.
⁶ Department of Anesthesiology and Critical Care, Children's Medical Center Dallas, Dallas, TX, USA; University of Texas Southwestern, Dallas, TX, USA.
⁷ University of Washington, Seattle, WA, USA; Department of Anesthesiology and Pain Management, Seattle Children's Hospital, Seattle, WA, USA.
⁸ Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.

PMID: 30686307
DOI: 10.1016/j.bja.2018.10.061

Abstract

Background: The current incidence of major complications in paediatric craniofacial surgery in North America has not been accurately defined. In this report, the Pediatric Craniofacial Collaborative Group evaluates the incidence and determines the independent predictors of major perioperative complications using a multicentre database.

Methods: The Pediatric Craniofacial Surgery Perioperative Registry was queried for subjects undergoing complex cranial vault reconstruction surgery over a 5-year period. Major perioperative complications were identified through a structured a priori consensus process. Logistic regression was applied to identify predictors of a major perioperative complication with bootstrapping to evaluate discrimination accuracy and provide internal validity of the multivariable model.

Results: A total of 1814 patients from 33 institutions in the US and Canada were analysed; 15% were reported to have a major perioperative complication. Multivariable predictors included ASA physical status 3 or 4 (P=0.005), craniofacial syndrome (P=0.008), antifibrinolytic administered (P=0.003), blood product transfusion >50 ml kg^-1 (P<0.001), and surgery duration over 5 h (P<0.001). Bootstrapping indicated that the predictive algorithm had good internal validity and excellent discrimination and model performance. A perioperative complication was estimated to increase the hospital length of stay by an average of 3 days (P<0.001).

Conclusions: The predictive algorithm can be used as a prognostic tool to risk stratify patients and thereby potentially reduce morbidity and mortality. Craniofacial teams can utilise these predictors of complications to identify high-risk patients. Based on this information, further prospective quality improvement initiatives may decrease complications, and reduce morbidity and mortality.

Keywords: craniosynostosis; multivariable model; paediatrics; perioperative complications; perioperative outcome; predictive algorithm; risk assessment.

Publication types

Multicenter Study
Observational Study

MeSH terms

Adolescent
Algorithms
Child
Child, Preschool
Craniosynostoses / surgery*
Female
Humans
Incidence
Intraoperative Complications / epidemiology
Intraoperative Complications / etiology*
Length of Stay
Male
Plastic Surgery Procedures / adverse effects*
Plastic Surgery Procedures / methods
Postoperative Complications / epidemiology
Postoperative Complications / etiology*
Predictive Value of Tests
Reproducibility of Results
Retrospective Studies
Risk Assessment