Perioperative Outcomes in Pediatric Cranial Vault Reconstruction: Does Size Matter?
Brad A. Morrow, MD1, Kanlaya Ditthakasem, M.N.S., R.N.2, Morley Herbert, Ph.D.2, Jeffrey Fearon, M.D.1.
1The Craniofacial Center, Dallas, TX, USA, 2Department of Clinical Research, Medical City Dallas Hospital, Dallas, TX, USA.
Purpose: The Pediatric Craniofacial Collaborative Group recently reported pooled perioperative management and outcome data for open cranial vault remodeling procedures. We sought to determine if outcomes might be different at a single higher-volume center and, if identified, examine why and propose strategies for improvement.
Methods: A retrospective review was performed of all open pediatric cranial vault procedures performed at our center during the identical 39-month period reported by the Collaborative group, including demographic, perioperative management and outcome data, to permit multiple comparative analyses.
Results: 310 procedures were performed by our center, compared to 1223 by the combined 31 institutions (reported median: 29.5 cases/center; range: 12-54.5). Multiple differences were found: our higher-volume center had a significantly lower intraoperative red blood cell transfusion rate (5.8% versus 87.8%, p<0.001) and those requiring transfusions were transfused smaller volumes (half-total blood volume transfusions: 0.6% versus 26.8%; total blood volume transfusions: 0 versus 4.1%; both p < 0.001), and exposure to ≥3 blood donors was significantly less (1% versus 20%, p<0.001). There were no mortalities in either group, but identical adverse events were fewer at our center (5.2% versus 22.8%, p < 0.001), as were ICU and hospital lengths of stay (1 versus 2 days, 2 versus 4.5 days, both p<0.001).
Conclusions: Outcomes following pediatric cranial vault remodeling procedures performed at a single higher-volume center appeared superior to the combined averages reported by the Pediatric Craniofacial Collaborative Group. We propose numerous strategies to improve outcomes, including: standardizing specific blood conservation techniques and adoption of safety protocols.
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