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The Evolution of Surgical Techniques in Craniosynostosis: A Single-Center, Multi-Surgeon Retrospective Review of Sagittal Synostosis Correction Techniques and Outcomes Data at a Regional Pediatric Cra
Dustin C Derrick, MD; Dylan R Childs, MD; Nathan M Fagan, MD; Anna M Widmyer, MD; Ananth S Murthy, MD; Michael G Parker, MD; James A Lehman Jr., MD; Niyant V Patel, MD
Summa Health System/Akron Children's Hospital Craniofacial Center
2016-02-29
Presenter: Dustin C Derrick, MD
Affidavit:
100% of the work done on this project is the work of the residents, and has not been previously published.
Director Name: Douglas S Wagner, MD, FACS
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background: Sagittal craniosynostosis affects approximately 1/5000 live births, causes morphologic deformities, and pathological physiologic states. Akron Children's Hospital (ACH), a multi-disciplinary craniofacial center, has treated sagittal craniosynostosis with a variety of operative techniques.
Methods: Retrospective chart review of single-suture non-syndromic sagittal craniosynostosis, correction techniques, and outcomes data. Primary outcomes were cranial index (CI), operative times, blood loss (EBL), and transfusion rates.
Results: Initial results yielded 61 sagittal corrections with a mean follow-up of 41.9 months (6.6-195.5; >6mo for inclusion). Paired T-tests showed all techniques produced significant (p≤0.001) changes in pre/post-ΔCI. ANOVA analysis of pre/post-ΔCI (MS-85.29, df-3, F-4.58, p-0.006) shows significance, and follow-up subgroup analysis with Tukey-HSD testing showed significance for comparisons between ENDO/TGCVE and ENDO/TGCVE. ANOVA analysis of pre/recent-ΔCI (MS-19.59, df-3, F-1.34, p-0.2704) showed no significance, thus no Tukey-HSD testing was performed. Overall transfusion rates were 55.8%, with an unexpected significantly higher rate in the ENDO/PCVR group.
Conclusion: We provide mid/long-term follow-up with outcomes analysis of multiple surgical techniques. All techniques showed significance independently in short-term ΔCI, but this inter-group difference seemed to diminish in significance over longer periods of follow-up. Operative times were shorter with ENDO group as expected. We're analyzing the differences in transfusion rates given our hypothesis this observation is attributable implementing the PCVR technique and blood-sparing protocols in 2014. This difference is of particular importance given the significantly higher EBL in the PCVR group compared to the ENDO group on subgroup analysis with Tukey-HSD post-ANOVA testing.
