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Perioperative Complications Associated With Intracranial Procedures in Patients With Nonsyndromic Single-Suture Craniosynostosis

Tahiri, Youssef MD, CM*; Paliga, James Thomas BA; Wes, Ari M. BA; Whitaker, Linton A. MD; Bartlett, Scott P. MD; Taylor, Jesse A. MD

The Journal of Craniofacial Surgery: January 2015 - Volume 26 - Issue 1 - p 118–123
doi: 10.1097/SCS.0000000000001316
Original Articles

Within the diagnosis “craniosynostosis,” there is a subset of patients who present with isolated, nonsyndromic, single-suture involvement. This study evaluates perioperative complications in this specific subset of patients over 4 decades at a single institution. To do so, we performed a retrospective review on consecutive patients undergoing correction of single-suture synostosis from May 1977 to January 2013 at a tertiary pediatric craniofacial center. Demographic information, operative details, and perioperative course were collected. Complications were categorized as either major or minor. A χ2 test and Fisher exact test were used to compare all categorical variables. Continuous variables were analyzed using Wilcoxon rank-sum and Kruskal-Wallis tests.

Seven hundred forty-six patients underwent surgical correction of nonsyndromic craniosynostosis. Of these, there were 307 (41.2%) sagittal, 201 (26.9%) metopic, and 238 (31.9%) unicoronal. Thirty-four patients had complications (4.6%). Eight were considered major (1.1%), including one postoperative mortality in a patient with hypoplastic left-sided heart syndrome. Minor complications occurred in 26 patients (3.5%) and included subgaleal hematoma (n = 3), seroma (n = 4), and superficial wound infection (n = 5). Metopic and sagittal suture involvement was significantly associated with a higher complication rate (P = 0.04). A child with isolated single suture synostosis and any comorbidity had a significantly greater risk of any complication (P < 0.001; odds ratio, 3.8) and specifically an increased risk of major complication (P = 0.031; odds ratio, 6.0). Subclassification of patients by time period yielded no statistically significant changes in perioperative morbidity. To conclude, these data allow us to counsel families more accurately with regard to morbidity and mortality and may potentially serve as a benchmark for future quality improvement work.

From the *Division of Plastic Surgery, Indiana University, Riley Hospital for Children, Indianapolis, IN; and †Division of Plastic Surgery, The Perelman School of Medicine at the University of Pennsylvania, The Children’s Hospital of Philadelphia, Philadelphia, PA.

Received July 29, 2014.

Accepted for publication September 13, 2014.

Address correspondence and reprint requests to Jesse A. Taylor, MD, The Perelman School of Medicine at the University of Pennsylvania, The Children’s Hospital of Philadelphia, Colket Translational Research Bldg, 3501 Civic Center Blvd, 9th Floor, Philadelphia, PA 19104; E-mail:

This study was reviewed and approved by the Institutional Review Board of the Children’s Hospital of Philadelphia.

This study was funded by the Department of Surgery of The Children’s Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania.

The data included in this article have been presented at the 93rd American Association of Plastic Surgeons Meeting in Miami, FL, April 7, 2014.

The authors report no conflicts of interest.

© 2015 by Mutaz B. Habal, MD.