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

Pediatric Craniofacial Collaborative Group

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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.

Original languageEnglish (US)
Pages (from-to)1069-1078
Number of pages10
JournalAnesthesia and analgesia
Volume129
Issue number4
DOIs
StatePublished - Oct 1 2019

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Multicenter Studies
Observational Studies
Length of Stay
Pediatrics
Blood Donors
Craniosynostoses
Blood Transfusion
Intensive Care Units
Registries
Demography
Outcome Assessment (Health Care)
Incidence

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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

In: Anesthesia and analgesia, Vol. 129, No. 4, 01.10.2019, p. 1069-1078.

Research output: Contribution to journalArticle

@article{1abd0355445d4db2886f6a00c6cffc9c,
title = "Perioperative Outcomes and Surgical Case Volume in Pediatric Complex Cranial Vault Reconstruction: A Multicenter Observational Study From the Pediatric Craniofacial Collaborative Group",
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.",
author = "{Pediatric Craniofacial Collaborative Group} and Fernandez, {Allison M.} and Reddy, {Srijaya K.} and Heather Gordish-Dressman and Muldowney, {Bridget L.} and Martinez, {Jos{\'e} Luis} and Franklin Chiao and Stricker, {Paul A.} and Christopher Abruzzese and Jesus Apuya and Amy Beethe and Hubert Benzon and Wendy Binstock and Alyssa Brzenski and Stefan Budac and Veronica Busso and Surendrasingh Chhabada and Franklyn Cladis and Danielle Claypool and Michael Collins and Rachel Dabek and Nicholas Dalesio and Ricardo Falcon and Patrick Fernandez and John Fiadjoe and Meera Gangadharan and Katherine Gentry and Chris Glover and Goobie, {Susan M.} and Amanda Gosman and Shannon Grap and Heike Gries and Allison Griffin and Charles Haberkern and John Hajduk and Rebecca Hall and Jennifer Hansen and Mali Hetmaniuk and Vincent Hsieh and Henry Huang and Pablo Ingelmo and Iskra Ivanova and Ranu Jain and Michelle Kars and Courtney Kowalczyk-Derderian and Jane Kugler and Kristen Labovsky and Indrani Lakheeram and Andrew Lee and Brian Masel and Peter Szmuk",
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language = "English (US)",
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T1 - Perioperative Outcomes and Surgical Case Volume in Pediatric Complex Cranial Vault Reconstruction

T2 - A Multicenter Observational Study From the Pediatric Craniofacial Collaborative Group

AU - Pediatric Craniofacial Collaborative Group

AU - Fernandez, Allison M.

AU - Reddy, Srijaya K.

AU - Gordish-Dressman, Heather

AU - Muldowney, Bridget L.

AU - Martinez, José Luis

AU - Chiao, Franklin

AU - Stricker, Paul A.

AU - Abruzzese, Christopher

AU - Apuya, Jesus

AU - Beethe, Amy

AU - Benzon, Hubert

AU - Binstock, Wendy

AU - Brzenski, Alyssa

AU - Budac, Stefan

AU - Busso, Veronica

AU - Chhabada, Surendrasingh

AU - Cladis, Franklyn

AU - Claypool, Danielle

AU - Collins, Michael

AU - Dabek, Rachel

AU - Dalesio, Nicholas

AU - Falcon, Ricardo

AU - Fernandez, Patrick

AU - Fiadjoe, John

AU - Gangadharan, Meera

AU - Gentry, Katherine

AU - Glover, Chris

AU - Goobie, Susan M.

AU - Gosman, Amanda

AU - Grap, Shannon

AU - Gries, Heike

AU - Griffin, Allison

AU - Haberkern, Charles

AU - Hajduk, John

AU - Hall, Rebecca

AU - Hansen, Jennifer

AU - Hetmaniuk, Mali

AU - Hsieh, Vincent

AU - Huang, Henry

AU - Ingelmo, Pablo

AU - Ivanova, Iskra

AU - Jain, Ranu

AU - Kars, Michelle

AU - Kowalczyk-Derderian, Courtney

AU - Kugler, Jane

AU - Labovsky, Kristen

AU - Lakheeram, Indrani

AU - Lee, Andrew

AU - Masel, Brian

AU - Szmuk, Peter

PY - 2019/10/1

Y1 - 2019/10/1

N2 - 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.

AB - 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.

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U2 - 10.1213/ANE.0000000000003515

DO - 10.1213/ANE.0000000000003515

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VL - 129

SP - 1069

EP - 1078

JO - Anesthesia and Analgesia

JF - Anesthesia and Analgesia

SN - 0003-2999

IS - 4

ER -