Is PICU Care Necessary For Spring-Mediated Cranioplasty Patients?
Viren Patel, BS1, Robin Yang, MD, DDS2, Sameer Shakir, MD1, Scott Bartlett, MD2, Jordan Swanson, MD2, Jesse Taylor2.
1Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA, 2Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Background: The sagittal suture is the most frequently involved suture in craniosynostosis patients. In recent years, Spring-Mediated Cranioplasty(SMC) has emerged as an effective and safe technique to treat patients with sagittal craniosynostosis. When compared to cranial vault remodeling, SMC has been shown to achieve equivalent skull widening and carries less perioperative risk. Despite this, SMC patients regularly go to the PICU after surgery due to beliefs that these patients are at high risk of neurologic and hemodynamic deterioration. This study aims to determine if PICU care is truly indicated in SMC patients.
Methods: A retrospective chart review of all patients treated with SMC for sagittal craniosynostosis from 2011 to 2018 was conducted. Patient demographics, including age and sex, and operative information were recorded. Post-operative outcomes were also recorded, with a focus on complications that would necessitate ICU level care, like hemodynamic instability or altered neurological status, in addition to hospital stay information, like length of stay and total time spent in the PICU. Standard descriptive statistics were used.
Results: A total of 65 patients(48 Males, 74%) underwent SMC at our institution during the study period. The average age at the time of operation was 113±30 days and the average operative time was 2.32±0.99 hours, with 17 patients(26%) requiring intraoperative transfusions. Overall, only two patients(3.1%) showed signs of hemodynamic instability and zero patients(0%) had altered mental status. Six patients(9.2%) did require blood transfusions for post-operative anemia, which was discovered on routine blood work. One patient(1.5%) required take back to OR for a dislodged spring discovered on skull X-ray. On average, patients spent 34.9±14 hours in the PICU, and 47 patients(72%) were discharged directly home from the PICU without being first transferred to the floors.
Conclusion: SMC is a safe and effective procedure to treat sagittal craniosynostosis, and most patients do not require PICU care in the post-operative period. Post-operative anemia is the most common complication, but is generally detected on routine bloodwork and can be addressed on the floors. While two patients did have hemodynamic instability in the post-operative period, both of these patients had pre-existing conditions that would place them at higher risk of complications after any procedure that required general anesthesia. Overall, the findings from this study suggest that SMC patients without concomitant risk factors can be safely discharged to the floors after surgery.
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