Grove, Austin

Objective To compare perioperative outcomes, complications, imaging utilization, and device management following posterior vault distraction osteogenesis (PVDO) and spring-mediated cranioplasty (SMC) for multisutural craniosynostosis. Design Retrospective cohort study. Setting Single pediatric tertiary care center. Patients, Participants Twenty-three patients with multisutural craniosynostosis treated between 2017 and 2025 (PVDO, n = 18; SMC, n = 5). Interventions PVDO or SMC. Main Outcome Measure(s) Time to device removal, imaging utilization, reoperations, readmissions, device-related complications, revision surgeries, wound infections, and absolute intracranial volume change. Results PVDO was associated with earlier device removal than SMC (78.7 ± 22.1 vs. 133.0 ± 27.4 days; P = .0015) but greater postoperative imaging utilization during the first year (5.33 ± 1.28 vs. 2.80 ± 1.64 studies; P = .01). Rates of reoperation (22.2% vs. 0%), readmission (22.2% vs. 40.0%), device-related complications (11.1% vs. 0%), revision surgery (16.7% vs. 0%), and wound infection (22.2% vs. 20.0%) did not differ significantly (all P ≥ .50). Preoperative imaging utilization and postoperative intracranial volume gain were comparable between groups. Conclusions PVDO and SMC demonstrated similar safety profiles and intracranial volume expansion in patients with multisutural craniosynostosis. Compared with SMC, PVDO enabled earlier device removal but required increased postoperative imaging. These findings may inform operative planning, postoperative surveillance, and family counseling. Larger, multicenter studies with longer follow-up are needed to evaluate long-term outcomes.

Craniofacial surgery requires a multidisciplinary care approach in the perioperative period. In an effort to guide clinical decision making and standardize care, many institutions have implemented craniofacial surgical pathways, describing numerous variables to monitor and specific actions that must be completed by each involved discipline in the perioperative period. Adherence to these pathways can be challenging given the complexity of the protocol and the multiple disciplines involved. In an effort to improve adherence to our institution’s perioperative pathway, the authors implemented a quarterly, multidisciplinary craniofacial operative team meeting to review the pathway and improve the quality of care. The authors report results from a retrospective review of craniosynostosis suturectomy operations at a single site in the 2 years before and 2 years after the start of our team meeting to review perioperative care. A total of 141 operations were included (70 before the meeting and 71 after). Perioperative outcomes and adherence to our surgical pathway were compared. Following the start of our team meetings, there was a significant decrease in the time under anesthesia, patients requiring blood transfusion, and total hospital length of stay ( P <0.05). There was also improved adherence to the craniofacial pathway, with significantly more operations applying peripheral nerve blocks to all locations specified in our pathway with the proper drug contents ( P <0.05). Our findings suggest that craniofacial operative team meetings with a goal of reviewing the surgical pathway and discussing improvements in care plans with all involved providers can significantly improve adherence to operative pathways and surgical outcomes.