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Analysis of Routine Intensive Care Unit Admission following Fronto-Orbital Advancement for Craniosynostosis

Seruya, Mitchel M.D.; Sauerhammer, Tina M. M.D.; Basci, Deniz M.D.; Rogers, Gary F. M.D., J.D.; Boyajian, Michael J. M.D.; Myseros, John S. M.D.; Yaun, Amanda L. M.D.; Keating, Robert F. M.D.; Oh, Albert K. M.D.

Plastic & Reconstructive Surgery: April 2013 - Volume 131 - Issue 4 - p 582e–588e
doi: 10.1097/PRS.0b013e3182818e94
Pediatric/Craniofacial: Original Articles

Background: Intensive care unit admission following fronto-orbital advancement for craniosynostosis is routine at most institutions. The authors determined the frequency of postoperative events requiring intensive care unit care that justify this practice.

Methods: Infants with craniosynostosis who underwent primary fronto-orbital advancement at a single institution from 1997 to 2011 were included. Patient demographics, operative factors, and hemodynamic outcomes were recorded. Adverse postoperative events/interventions were graded as none (group I); minor (group II), easily managed on a surgical floor; or major (group III), requiring intensive care unit care.

Results: One hundred seven infants were included. Average length of hospitalization was 3.7 ± 1.6 days, with 1.3 ± 1.0 days in the intensive care unit and 2.4 ± 1.0 days on the floor. Seventy-eight patients (72.9 percent) were categorized into group I, 24 (22.4 percent) into group II, and five (4.7 percent) into group III. Major events/interventions included prolonged intubation (n = 2), reintubation (n = 2), and continuous positive airway pressure support (n = 1). Preexisting end-organ dysfunction was significantly associated with group III patients, who also had significantly higher intraoperative blood loss requiring greater resuscitation. Mean daily charges were $7652.33 (10.9 percent of total charges) for intensive care unit care and $2470.62 (6.9 percent of total charges) for floor care.

Conclusions: In this study, 4.7 percent of patients had event/interventions requiring intensive care unit care after fronto-orbital advancement. Predictors included preexisting end-organ dysfunction and higher intraoperative blood loss requiring greater resuscitation. Financial savings from selective postoperative intensive care unit admission may not outweigh the potential cost of an emergent event on the surgical floor.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Washington, D.C.

From the Departments of Plastic Surgery and Neurosurgery at Children's National Medical Center and the George Washington School of Medicine.

Received for publication May 29, 2012; accepted September 20, 2012.

Presented in part at the 2012 American Society of Plastic Surgeons Senior Residents Conference, in Tampa Bay, Florida, January 19 through 21, 2012, and at the 91st Annual Meeting of the American Association of Plastic Surgeons, in San Francisco, California, April 14 through 17, 2012.

Disclosure: The authors have no financial or commercial interests to disclose.

Albert K. Oh, M.D.; Department of Plastic and Reconstructive Surgery, Children's National Medical Center, 111 Michigan Avenue NW, 4th Floor West Wing, Washington, D.C. 20010, aoh@cnmc.org

©2013American Society of Plastic Surgeons