Perioperative Outcomes and Surgical Case Volume in Pediatric Complex Cranial Vault Reconstruction: A Multicenter Observational Study From the Pediatric Craniofacial Collaborative Group

BACKGROUND:Complex cranial vault reconstruction (CCVR) performed to treat craniosynostosis can be associated with significant blood loss, transfusion, and perioperative complications. The aim of this study was to examine the effect of CCVR surgical case volume on perioperative outcomes. We hypothesi...

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Published inAnesthesia and analgesia Vol. 129; no. 4; pp. 1069 - 1078
Main Authors Fernandez, Allison M, Reddy, Srijaya K, Gordish-Dressman, Heather, Muldowney, Bridget L, Martinez, José Luis, Chiao, Franklin, Stricker, Paul A, Abruzzese, Christopher, Apuya, Jesus, Beethe, Amy, Benzon, Hubert, Binstock, Wendy, Brzenski, Alyssa, Budac, Stefan, Busso, Veronica, Chhabada, Surendrasingh, Cladis, Franklyn, Claypool, Danielle, Collins, Michael, Dabek, Rachel, Dalesio, Nicholas, Falcon, Ricardo, Fernandez, Patrick, Fiadjoe, John, Gangadharan, Meera, Gentry, Katherine, Glover, Chris, Goobie, Susan M, Gosman, Amanda, Grap, Shannon, Gries, Heike, Griffin, Allison, Haberkern, Charles, Hajduk, John, Hall, Rebecca, Hansen, Jennifer, Hetmaniuk, Mali, Hsieh, Vincent, Huang, Henry, Ingelmo, Pablo, Ivanova, Iskra, Jain, Ranu, Kars, Michelle, Kowalczyk-Derderian, Courtney, Kugler, Jane, Labovsky, Kristen, Lakheeram, Indrani, Lee, Andrew, Martinez, Jose Luis, Masel, Brian, Medellin, Eduardo, Meier, Petra, Mitzel Levy, Heather, Muhly, Wallis T, Nelson, Jonathon, Nicholson, Julie, Nguyen, Kim-Phuong, Nguyen, Thanh, Olutuye, Olutoyin, Owens-Stubblefield, Margaret, Ramesh Parekh, Uma, Petersen, Timothy, Pohl, Vanessa, Post, Julian, Poteet-Schwartz, Kim, Prozesky, Jansie, Reid, Russell, Ricketts, Karene, Rubens, Daniel, Ryan, Laura, Skitt, Rochelle, Soneru, Codruta, Spitznagel, Rachel, Singh, Davinder, Singhal, Neil R, Sorial, Emad, Staudt, Susan, Stubbeman, Bobbie, Sung, Wai, Syed, Tariq, Szmuk, Peter, Taicher, Brad M, Thompson, Douglas, Tretault, Lisa, Ungar-Kastner, Galit, Watts, Rheana, Wieser, John, Wong, Karen, Zamora, and Lillian
Format Journal Article
LanguageEnglish
Published United States International Anesthesia Research Society 01.10.2019
Subjects
Adolescent
Adult
Age Factors
Blood Loss, Surgical - prevention & control
Blood Transfusion
Child
Craniosynostoses - diagnostic imaging
Craniosynostoses - epidemiology
Craniosynostoses - surgery
Female
Hospitals, High-Volume
Hospitals, Low-Volume
Humans
Incidence
Intensive Care Units
Length of Stay
Male
Perioperative Period
Postoperative Complications - epidemiology
Postoperative Complications - therapy
Reconstructive Surgical Procedures - adverse effects
Registries
Risk Factors
Time Factors
Treatment Outcome
Young Adult
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Abstract BACKGROUND:Complex cranial vault reconstruction (CCVR) performed to treat craniosynostosis can be associated with significant blood loss, transfusion, and perioperative complications. The aim of this study was to examine the effect of CCVR surgical case volume on perioperative outcomes. We hypothesized that surgical case volume is not associated with differences in perioperative outcomes. The study primary outcome was total perioperative blood donor exposures. Secondary outcomes included the total perioperative transfusion volume, major complications, and intensive care unit and hospital length of stay. METHODS:The multicenter Pediatric Surgery Perioperative Registry was queried for infants and children undergoing CCVR between June 2012 and September 2016. Institutions were categorized into low, middle, or high surgical case volume groups based on tertiles of the average number of cases performed per month. Primary and secondary outcomes were analyzed with respect to these groupings. RESULTS:The query yielded 1814 CCVR cases from 33 institutions. Demographics were similar among the 3 study groups. An inverse relationship between surgical case volume and total perioperative blood donor exposures was observed (P < .001). The low-volume group had higher perioperative transfusion volumes (P = .02 versus middle; P = .01 versus high). There was no significant relationship between surgical case volume and the incidence of major postoperative complications or hospital length of stay. CONCLUSIONS:In this study, low surgical case volumes were associated with increased total blood donor exposures and increased perioperative transfusion volumes. Hospital length of stay was homogeneous in the 3 groups, suggesting a limited overall clinical impact of the observed transfusion outcome differences.
AbstractList BACKGROUND:Complex cranial vault reconstruction (CCVR) performed to treat craniosynostosis can be associated with significant blood loss, transfusion, and perioperative complications. The aim of this study was to examine the effect of CCVR surgical case volume on perioperative outcomes. We hypothesized that surgical case volume is not associated with differences in perioperative outcomes. The study primary outcome was total perioperative blood donor exposures. Secondary outcomes included the total perioperative transfusion volume, major complications, and intensive care unit and hospital length of stay. METHODS:The multicenter Pediatric Surgery Perioperative Registry was queried for infants and children undergoing CCVR between June 2012 and September 2016. Institutions were categorized into low, middle, or high surgical case volume groups based on tertiles of the average number of cases performed per month. Primary and secondary outcomes were analyzed with respect to these groupings. RESULTS:The query yielded 1814 CCVR cases from 33 institutions. Demographics were similar among the 3 study groups. An inverse relationship between surgical case volume and total perioperative blood donor exposures was observed (P < .001). The low-volume group had higher perioperative transfusion volumes (P = .02 versus middle; P = .01 versus high). There was no significant relationship between surgical case volume and the incidence of major postoperative complications or hospital length of stay. CONCLUSIONS:In this study, low surgical case volumes were associated with increased total blood donor exposures and increased perioperative transfusion volumes. Hospital length of stay was homogeneous in the 3 groups, suggesting a limited overall clinical impact of the observed transfusion outcome differences.
BACKGROUNDComplex cranial vault reconstruction (CCVR) performed to treat craniosynostosis can be associated with significant blood loss, transfusion, and perioperative complications. The aim of this study was to examine the effect of CCVR surgical case volume on perioperative outcomes. We hypothesized that surgical case volume is not associated with differences in perioperative outcomes. The study primary outcome was total perioperative blood donor exposures. Secondary outcomes included the total perioperative transfusion volume, major complications, and intensive care unit and hospital length of stay. METHODSThe multicenter Pediatric Surgery Perioperative Registry was queried for infants and children undergoing CCVR between June 2012 and September 2016. Institutions were categorized into low, middle, or high surgical case volume groups based on tertiles of the average number of cases performed per month. Primary and secondary outcomes were analyzed with respect to these groupings. RESULTSThe query yielded 1814 CCVR cases from 33 institutions. Demographics were similar among the 3 study groups. An inverse relationship between surgical case volume and total perioperative blood donor exposures was observed (P < .001). The low-volume group had higher perioperative transfusion volumes (P = .02 versus middle; P = .01 versus high). There was no significant relationship between surgical case volume and the incidence of major postoperative complications or hospital length of stay. CONCLUSIONSIn this study, low surgical case volumes were associated with increased total blood donor exposures and increased perioperative transfusion volumes. Hospital length of stay was homogeneous in the 3 groups, suggesting a limited overall clinical impact of the observed transfusion outcome differences.
BACKGROUND: Complex cranial vault reconstruction (CCVR) performed to treat craniosynostosis can be associated with significant blood loss, transfusion, and perioperative complications. The aim of this study was to examine the effect of CCVR surgical case volume on perioperative outcomes. We hypothesized that surgical case volume is not associated with differences in perioperative outcomes. The study primary outcome was total perioperative blood donor exposures. Secondary outcomes included the total perioperative transfusion volume, major complications, and intensive care unit and hospital length of stay. METHODS: The multicenter Pediatric Surgery Perioperative Registry was queried for infants and children undergoing CCVR between June 2012 and September 2016. Institutions were categorized into low, middle, or high surgical case volume groups based on tertiles of the average number of cases performed per month. Primary and secondary outcomes were analyzed with respect to these groupings. RESULTS: The query yielded 1814 CCVR cases from 33 institutions. Demographics were similar among the 3 study groups. An inverse relationship between surgical case volume and total perioperative blood donor exposures was observed ( P < .001). The low-volume group had higher perioperative transfusion volumes ( P = .02 versus middle; P = .01 versus high). There was no significant relationship between surgical case volume and the incidence of major postoperative complications or hospital length of stay. CONCLUSIONS: In this study, low surgical case volumes were associated with increased total blood donor exposures and increased perioperative transfusion volumes. Hospital length of stay was homogeneous in the 3 groups, suggesting a limited overall clinical impact of the observed transfusion outcome differences.
Complex cranial vault reconstruction (CCVR) performed to treat craniosynostosis can be associated with significant blood loss, transfusion, and perioperative complications. The aim of this study was to examine the effect of CCVR surgical case volume on perioperative outcomes. We hypothesized that surgical case volume is not associated with differences in perioperative outcomes. The study primary outcome was total perioperative blood donor exposures. Secondary outcomes included the total perioperative transfusion volume, major complications, and intensive care unit and hospital length of stay. The multicenter Pediatric Surgery Perioperative Registry was queried for infants and children undergoing CCVR between June 2012 and September 2016. Institutions were categorized into low, middle, or high surgical case volume groups based on tertiles of the average number of cases performed per month. Primary and secondary outcomes were analyzed with respect to these groupings. The query yielded 1814 CCVR cases from 33 institutions. Demographics were similar among the 3 study groups. An inverse relationship between surgical case volume and total perioperative blood donor exposures was observed (P < .001). The low-volume group had higher perioperative transfusion volumes (P = .02 versus middle; P = .01 versus high). There was no significant relationship between surgical case volume and the incidence of major postoperative complications or hospital length of stay. In this study, low surgical case volumes were associated with increased total blood donor exposures and increased perioperative transfusion volumes. Hospital length of stay was homogeneous in the 3 groups, suggesting a limited overall clinical impact of the observed transfusion outcome differences.
Author Apuya, Jesus
Reid, Russell
Fiadjoe, John
Hall, Rebecca
Sorial, Emad
Stricker, Paul A
Falcon, Ricardo
Nguyen, Thanh
Spitznagel, Rachel
Ramesh Parekh, Uma
Wieser, John
Busso, Veronica
Kowalczyk-Derderian, Courtney
Griffin, Allison
Lakheeram, Indrani
Labovsky, Kristen
Petersen, Timothy
Nguyen, Kim-Phuong
Prozesky, Jansie
Singh, Davinder
Masel, Brian
Post, Julian
Benzon, Hubert
Beethe, Amy
Szmuk, Peter
Hetmaniuk, Mali
Gentry, Katherine
Taicher, Brad M
Binstock, Wendy
Abruzzese, Christopher
Gangadharan, Meera
Medellin, Eduardo
Martinez, José Luis
Ivanova, Iskra
Dalesio, Nicholas
Glover, Chris
Hajduk, John
Watts, Rheana
Wong, Karen
Fernandez, Patrick
Staudt, Susan
Chhabada, Surendrasingh
Collins, Michael
Grap, Shannon
Owens-Stubblefield, Margaret
Singhal, Neil R
Sung, Wai
Gordish-Dressman, Heather
Soneru, Codruta
Ungar-Kastner, Galit
Brzenski, Alyssa
Nicholson, Julie
Cladis, Franklyn
Poteet-Schwartz, Kim
Nelson, Jonathon
Kars, Michelle
Kugler, Jane
Chiao, Franklin
Meier, Petra
Gries, Heike
Muldowney, Bridget L
Goobie, Susan M
Muhly, Wallis T
Ryan, Laura
AuthorAffiliation Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
From the Department of Anesthesia, Perioperative and Pain Medicine, Johns Hopkins All Children’s Hospital, St Petersburg, Florida
Center for Translational Science, Children’s National Health System/The George Washington University School of Medicine and Health Sciences, Washington, DC
Department of Pediatric Anesthesia, CHU Sainte-Justine/University of Montreal, Montreal, Québec, Canada
Department of Anesthesiology, New York Presbyterian Hospital-Weill Cornell Medical College, New York, New York
Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
Department of Anesthesiology, Monroe Carell Jr Children’s Hospital/Vanderbilt University Medical Center, Nashville, Tennessee
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– name: Department of Anesthesiology, New York Presbyterian Hospital-Weill Cornell Medical College, New York, New York
– name: Department of Pediatric Anesthesia, CHU Sainte-Justine/University of Montreal, Montreal, Québec, Canada
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BackLink https://www.ncbi.nlm.nih.gov/pubmed/30222655$$D View this record in MEDLINE/PubMed
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ContentType Journal Article
Contributor Apuya, Jesus
Fernandez, Allison
Reid, Russell
Fiadjoe, John
Hall, Rebecca
Sorial, Emad
Falcon, Ricardo
Nguyen, Thanh
Spitznagel, Rachel
Wieser, John
Busso, Veronica
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Snippet BACKGROUND:Complex cranial vault reconstruction (CCVR) performed to treat craniosynostosis can be associated with significant blood loss, transfusion, and...
Complex cranial vault reconstruction (CCVR) performed to treat craniosynostosis can be associated with significant blood loss, transfusion, and perioperative...
BACKGROUND: Complex cranial vault reconstruction (CCVR) performed to treat craniosynostosis can be associated with significant blood loss, transfusion, and...
BACKGROUNDComplex cranial vault reconstruction (CCVR) performed to treat craniosynostosis can be associated with significant blood loss, transfusion, and...
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SubjectTerms Adolescent
Adult
Age Factors
Blood Loss, Surgical - prevention & control
Blood Transfusion
Child
Craniosynostoses - diagnostic imaging
Craniosynostoses - epidemiology
Craniosynostoses - surgery
Female
Hospitals, High-Volume
Hospitals, Low-Volume
Humans
Incidence
Intensive Care Units
Length of Stay
Male
Perioperative Period
Postoperative Complications - epidemiology
Postoperative Complications - therapy
Reconstructive Surgical Procedures - adverse effects
Registries
Risk Factors
Time Factors
Treatment Outcome
Young Adult
Title Perioperative Outcomes and Surgical Case Volume in Pediatric Complex Cranial Vault Reconstruction: A Multicenter Observational Study From the Pediatric Craniofacial Collaborative Group
URI https://www.ncbi.nlm.nih.gov/pubmed/30222655
https://search.proquest.com/docview/2109335904
Volume 129
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