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Analysis of Morbidity and Mortality in Surgical Management of Craniosynostosis

Lee, Hui Qing MBBS; Hutson, John M. MD(Monash), DSc(Melb); Wray, Alison C. MBChB, FRACS; Lo, Patrick A. MBBS, BSc(Med); Chong, David K. MBBS, FRACS; Holmes, Anthony D. MBBS, FRACS; Greensmith, Andrew L. MBChB, FRACS

doi: 10.1097/SCS.0b013e31824e26d6
Original Articles

Multidisciplinary care involving plastic surgery and neurosurgery is generally accepted as optimal to manage craniosynostosis to avoid complications and to identify patients at risk. We conducted a retrospective 30-year review of craniosynostosis surgery at a single major craniofacial institute to establish the rate and predictors of complications. Medical records of 796 consecutive patients who underwent primary surgery for craniosynostosis from 1981 to 2010 at our institute were analyzed for complications. Complications were defined as intraoperative and postoperative adverse events requiring changed management. Reoperation was defined as a repeat transcranial procedure. Multivariate logistic regression was used to identify predictors for complications or revision. Across the years, the procedures evolved from technically simple to complex, which increased complications but better outcomes. Complications occurred in 111 patients (14%), and 33 (5.4%) needed major revision. Multivariate analysis identified multisuture and syndromic craniosynostosis, more recent surgeries, younger age (<9 months), spring-assisted cranioplasty, longer surgery, and greater transfusion as predictors of complications. Patients with syndromic and multisutural craniosynostosis and those operated on younger than 9 months had increased risk of major revision surgery for regression to phenotype. Our experience over 30 years indicates that pediatric transcranial craniosynostosis surgery can be safely carried out in our tertiary referral center. There were no deaths from primary surgery, and complication and reoperation rates mirror those of other published studies. Syndromic and complex craniosynostosis predicted both complications and need for major revision. Spring cranioplasty was associated with higher complications. Overall results support a recommended age for craniosynostosis surgery between 9 and 12 months.

From the Departments of Plastic and Maxillofacial Surgery, Urology and Neurosurgery, Royal Children’s Hospital, Victoria; and the Department of Paediatrics, University of Melbourne, Melbourne, Australia.

Received December 16, 2011.

Accepted for publication January 29, 2012.

Address correspondence and reprint requests to John M. Hutson, MD (Monash), DSc(Melb), BS, FRACS, FAAP, Department of Urology, Royal Children’s Hospital, Flemington Rd, Parkville, Victoria 3052, Australia; E-mail:

The authors report no conflicts of interest.

© 2012 Mutaz B. Habal, MD