Intraoperative Management by a Craniofacial Team Anesthesiologist is Associated With Improved Outcomes for Children Undergoing Major Craniofacial Reconstructive Surgery

The benefits of using a dedicated team for complex surgeries are well established for certain specialties, but largely unknown for others. The aim of this study was to determine whether management by a dedicated craniofacial team anesthesiologist would impact perioperative outcomes for children undergoing major surgery for craniosynostosis. Sixty-two children undergoing complex cranial vault reconstruction were identified. Fifty-four patients were managed by the craniofacial anesthesia team, while 8 patients were not. Primary outcome measures were calculated blood loss, red blood cell transfusion volume, blood donor exposures, extubation rate, and postoperative complication rate. Secondary outcome measures included intraoperative opioid administration, crystalloid and colloid administration, intraoperative complication rate, and intensive care unit (ICU) and hospital length of stay. Children cared for by the craniofacial team had significantly lower calculated blood loss, reduced red blood cell transfusion volume, fewer blood donor exposures, less crystalloid administration, higher rate of postoperative extubation, fewer postoperative complications, and decreased ICU and hospital length of stay than patients who were managed by noncraniofacial team anesthesiologists. There were no significant differences in demographics, opioid administration, colloid volume administration, or intraoperative complication rates between the 2 groups. Management by a craniofacial team anesthesiologist was associated with improved outcomes in children undergoing major craniofacial reconstructive surgery. While some variability can be attributed to provider-volume relationship, these findings suggest that children may benefit from a subspecialty anesthesia team-based approach for the management of craniofacial surgery, and potentially other similar high-risk cases. Address correspondence and reprint requests to Srijaya K. Reddy, MD, MBA, Department of Anesthesiology, Monroe Carell Jr Children's Hospital at Vanderbilt, 2200 Children's Way Suite 3116, Nashville, TN 37232; E-mail: srijaya.k.reddy@vanderbilt.edu Received 16 July, 2018 Accepted 1 September, 2018 This study was presented at American Society of Anesthesiologists (ASA) 2016 in Chicago, IL, Society for Pediatric Anesthesia (SPA) 2017 in Austin, TX, and International Anesthesia Research Society (IARS) 2017 in Washington, DC. The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

http://bit.ly/2F8C49X