gms | German Medical Science

Introduction: Tabulation of complications is a common way of evaluating craniosynostosis practice. Due to the lack of standartisation in the literature, objective comparison is often difficult. The authors propose a new classification that builds on prospective data collection and is designed to systematically capture significant morbidity and also near-misses. Its uses include quality improvement and benchmarking between different techniques and centres. The complications are broadly divided into: (0) perioperative occurrences; (1) inpatient complications; (2) outpatient complications not requiring re-admission; (3) complications requiring re-admission (subdivided into surgical and non-surgical); (4) unexpected long-term deficit; (5) mortality. A further detail of each type is made by taking into account post-operative length of stay and time between discharge and event occurrence.

Methods: Over a period between January 2010 and January 2015, complications for all non-syndromic patients undergoing surgery were prospectively collected by craniofacial nurse specialist. Patient demographics, medical background, details of surgery, and follow up were then retrospectively added on the basis of medical notes, anaesthetic and operation charts, and electronic databases. All syndromic cases were excluded. Complications were defined as any unexpected event which has or could have resulted in a temporary or permanent damage to the child.

Results: Analysis of 108 consecutive procedures in 103 non-syndromic craniosynostosis patients undergoing surgery is presented. Mean follow up was 15.1 months. There was a much higher incidence of complications according to the proposed definition (35.9%) than what is commonly reported. Patients with co-morbidities affecting at least two systems had significantly more complications (p=0.004, Fisher exact test).

Conclusions: It is the authors' opinion that no complications however minor should be discarded as they will cause distress to families, have an important role during counselling, and may suggest potential areas for service improvement.