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Major Morbidity and Mortality Rates in Craniofacial Surgery: An Analysis of 8101 Major Procedures

Czerwinski, Marcin M.D.; Hopper, Richard A. M.D.; Gruss, Joseph M.D.; Fearon, Jeffrey A. M.D.

Plastic and Reconstructive Surgery: July 2010 - Volume 126 - Issue 1 - p 181-186
doi: 10.1097/PRS.0b013e3181da87df
Pediatric/Craniofacial: Original Articles

Background: The first combined evaluation of morbidity and mortality rates in craniofacial surgery was published 30 years ago; many surgeons believe these procedures have since become safer. The authors performed a contemporary evaluation of craniofacial morbidity and mortality rates to help surgeons more accurately counsel families about current risks, and to gain insight into reducing future incidences.

Methods: This study used two methodologies to capture all serious morbidities and mortalities associated with major craniofacial procedures between 1990 and 2008: a comprehensive two-center retrospective review (Dallas and Seattle), and an Internet-based survey sent to all North American craniofacial centers.

Results: Combining the two-center data with the survey results yielded a database of 7328 intracranial and 773 subcranial procedures, for a total of 8101 major craniofacial procedures. The combined intracranial major morbidity rate was less than 0.1 percent, and the combined mortality rate was 0.1 percent. Of the eight perioperative deaths following intracranial procedures, four (50 percent) intracranial mortalities were directly attributed to blood loss. The combined subcranial procedure major morbidity rate was 0.1 percent and the mortality rate was 0.3 percent (airway related). Comparing the earliest published intracranial mortality rate to our current review revealed a statistically significant reduction in incidence (p < 0.001).

Conclusions: The incidence rates for serious morbidities and mortalities among major craniofacial procedures have significantly fallen since first published. On the basis of these analyses, the authors believe that a greater focus on protocols for airway management, blood salvage and replacement, age-appropriate deep venous thrombosis prophylaxis, and timing of subcranial midfacial advancements might result in further reductions in craniofacial mortality rates.

Dallas Texas; and Seattle, Wash.

From The Craniofacial Center and the Seattle Children's Craniofacial Center.

Received for publication October 16, 2009; accepted December 22, 2009.

Presented at the 88th Annual Meeting of the American Association of Plastic Surgeons, in Rancho Mirage, California, March 21 through 25, 2009.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

Jeffrey A. Fearon, M.D., The Craniofacial Center, 7777 Forest Lane, C-700, Dallas, Texas 75230,

©2010American Society of Plastic Surgeons