• Douglas R Thompson, David Zurakowski, Charles M Haberkern, Paul A Stricker, Petra M Meier, Carolyn Bannister, Hubert Benzon, Wendy Binstock, Adrian Bosenberg, Alyssa Brzenski, Stefan Budac, Veronica Busso, Samantha Capehart, Franklin Chiao, Franklyn Cladis, Michael Collins, Jordan Cusick, Rachel Dabek, Nicholas Dalesio, Ricardo Falcon, Allison Fernandez, Patrick Fernandez, John Fiadjoe, Meera Gangadharan, Katherine Gentry, Chris Glover, Susan Goobie, Heike Gries, Allison Griffin, Cornelius Botha Groenewald, John Hajduk, Rebecca Hall, Jennifer Hansen, Mali Hetmaniuk, Vincent Hsieh, Henry Huang, Pablo Ingelmo, Iskra Ivanova, Ranu Jain, Jeffrey Koh, Courtney Kowalczyk-Derderian, Jane Kugler, Kristen Labovsky, José Luis Martinez, Razaz Mujallid, Bridget Muldowney, Kim-Phuong Nguyen, Thanh Nguyen, Olutoyin Olutuye, Codruta Soneru, Timothy Petersen, Kim Poteet-Schwartz, Srijaya Reddy, Russell Reid, Karene Ricketts, Daniel Rubens, Rochelle Skitt, Lisa Sohn, Susan Staudt, Wai Sung, Tariq Syed, Peter Szmuk, Brad Taicher, Lisa Tetreault, Rheana Watts, Karen Wong, Vanessa Young, Lillian Zamora, and Pediatric Craniofacial Collaborative Group.
• From the Department of Anesthesiology and Pain Medicine, University of Washington-Seattle Children's Hospital, Seattle, Washington.
• Anesth. Analg. 2018 Mar 1; 126 (3): 968975968-975.

BackgroundThe 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.MethodsThirty-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.ResultsImbalances 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).ConclusionsThis 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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