PRS AAPS Oral Proofs 2016
Joseph Lopez, MD, MBA, Regina Cho, BA, Melanie Major, BA, Jens Berli, MD, Ricardo Bello, MD, Mundinger S. Gerhard, MD, Anh S. Edward, MD, Miguel Medina, III, MD, Amir H. Dorafshar, MBChB
From the Johns Hopkins Hospital, Baltimore, Md.
PURPOSE: The surgical correction of pediatric cranial deformities has in the past 2 decades undergone a large paradigm shift. The development of computer-aided design and manufacturing (CAD/CAM) has the potential to revolutionize craniofacial reconstruction. Although the adoption of CAD/CAM has rapidly expanded, there is a paucity of data exploring whether its use improves surgical outcomes over conventional methods.
METHODS: A retrospective cohort with matched design was conducted for patients with nonsyndromic craniosynostosis who underwent primary cranial vault remodeling from 2009 to 2015. Patient demographics and characteristics were recorded. Postoperative outcomes were assessed by assigning each procedure to a Whitaker category. Secondary postoperative outcomes were recorded including complications, operative time, and length of stay. We used parametric and nonparametric statistical tests for matched data to assess the association between use of CAD/CAM and surgical outcomes.
RESULTS: A total 40 patients were identified in this study period. CAD/CAM cases (n = 20) and matched controls (n = 20) did not differ in baseline characteristics. Whitaker scores of 2 or more were more common in CAD/CAM cases (25%) than controls (5%), which was statistically significant (P = 0.046). However, among secondary outcomes, we found no difference in intraoperative and postoperative complications between CAD/CAM cases and controls. Although the use of CAD/CAM was associated with shorter length of stay (P = 0.016), there was a trend toward longer operative time with the use of CAD/CAM (P = 0.052).
CONCLUSIONS: Our findings provide evidence that CAD/CAM may not improve the efficiency of craniofacial reconstruction and help optimize surgical outcomes.