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Cited by 102Craniofacial Disorders and TreatmentsPectus Deformity Diagnosis and TreatmentReconstructive Facial Surgery Techniques

Endoscopic Versus Open Repair for Craniosynostosis in Infants Using Propensity Score Matching to Compare Outcomes: A Multicenter Study from the Pediatric Craniofacial Collaborative Group

Thompson, Douglas R., Zurakowski, David, Haberkern, Charles M., Stricker, Paul A., Meier, Petra M.·2018·Anesthesia & Analgesia
DOI 10.1213/ane.0000000000002454
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Abstract

BACKGROUND: The North American Pediatric Craniofacial Collaborative Group (PCCG) established the Pediatric Craniofacial Surgery Perioperative Registry to evaluate outcomes in infants and children undergoing craniosynostosis repair. The goal of this multicenter study was to utilize this registry to assess differences in blood utilization, intensive care unit (ICU) utilization, duration of hospitalization, and perioperative complications between endoscopic-assisted (ESC) and open repair in infants with craniosynostosis. We hypothesized that advantages of ESC from single-center studies would be validated based on combined data from a large multicenter registry. METHODS: Thirty-one institutions contributed data from June 2012 to September 2015. We analyzed 1382 infants younger than 12 months undergoing open (anterior and/or posterior cranial vault reconstruction, modified-Pi procedure, or strip craniectomy) or endoscopic craniectomy. The primary outcomes included transfusion data, ICU utilization, hospital length of stay, and perioperative complications; secondary outcomes included anesthesia and surgical duration. Comparison of unmatched groups (ESC: N = 311, open repair: N = 1071) and propensity score 2:1 matched groups (ESC: N = 311, open repair: N = 622) were performed by conditional logistic regression analysis. RESULTS: Imbalances in baseline age and weight are inherent due to surgical selection criteria for ESC. Quality of propensity score matching in balancing age and weight between ESC and open groups was assessed by quintiles of the propensity scores. Analysis of matched groups confirmed significantly reduced utilization of blood (26% vs 81%, P < .001) and coagulation (3% vs 16%, P < .001) products in the ESC group compared to the open group. Median blood donor exposure (0 vs 1), anesthesia (168 vs 248 minutes) and surgical duration (70 vs 130 minutes), days in ICU (0 vs 2), and hospital length of stay (2 vs 4) were all significantly lower in the ESC group (all P < .001). Median volume of red blood cell administered was significantly lower in ESC (19.6 vs 26.9 mL/kg, P = .035), with a difference of approximately 7 mL/kg less for the ESC (95% confidence interval for the difference, 3-12 mL/kg), whereas the median volume of coagulation products was not significantly different between the 2 groups (21.2 vs 24.6 mL/kg, P = .73). Incidence of complications including hypotension requiring treatment with vasoactive agents (3% vs 4%), venous air embolism (1%), and hypothermia, defined as <35°C (22% vs 26%), was similar between the 2 groups, whereas postoperative intubation was significantly higher in the open group (2% vs 10%, P < .001). CONCLUSIONS: This multicenter study of ESC versus open craniosynostosis repair represents the largest comparison to date. It demonstrates striking advantages of ESC for young infants that may result in improved clinical outcomes, as well as increased safety.

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Crossref · 10.1213/ane.0000000000002454

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  • Endoscopic procedures have the advantage of requiring fewer skin incisions and less blood loss and are considered less invasive and more child-friendly.

    “They have the advantage of requiring fewer skin incisions and less blood loss and are therefore considered less invasive and more child-friendly [64,65,66,67,68,69,70].”

    From Isolated Sagittal Craniosynostosis: A Comprehensive Review (2024) · cites this paper as [70]

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Authors
Thompson, D. R., Zurakowski, D., Haberkern, C. M., Stricker, P. A., & Meier, P. M.
Affiliations
  • Seattle Children's Hospital (US)
  • Boston Children's Hospital (US)
  • Children's Hospital of Philadelphia (US)
Corresponding author
  • Thompson, Douglas R.
  • Haberkern, Charles M.
ORCID
Venue
Anesthesia & Analgesia
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2018-03
Volume
126
Issue
3
Pages
968-975
ISSN
0003-2999 (ISSN-L)
DOI
10.1213/ane.0000000000002454
OpenAlex
W2754226741
Cited by
100
References
21
Citations by year
2026: 16 · 2025: 17 · 2024: 18 · 2023: 7 · 2022: 7 · 2021: 10 · 2020: 9 · 2019: 5 · 2018: 11
FWCI
4.54
Type
journal article
Language
en
Open access
closed
Locations
  • Anesthesia & Analgesia (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Craniofacial Disorders and Treatments
  • Health Sciences › Medicine › Surgery › Pectus Deformity Diagnosis and Treatment
  • Health Sciences › Medicine › Surgery › Reconstructive Facial Surgery Techniques
Keywords
craniosynostosis, infants, perioperative outcomes, blood transfusion, intensive care utilization, length of hospital stay, perioperative complications, strip craniectomy, operative time, anesthesia duration, propensity score matching
MeSH terms
Craniosynostoses, Endoscopy, Female, Humans, Infant, Male, Prospective Studies, Registries, Treatment Outcome, Craniofacial Abnormalities, Plastic Surgery Procedures, Propensity Score

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