TY - JOUR
T1 - A European Multicenter Outcome Study of Perioperative Airway Management Policies following Midface Surgery in Syndromic Craniosynostosis
T2 - a proposal for a Standard Operating Procedure
AU - Cuperus, Iris E
AU - Mathijssen, Irene M J
AU - van Veelen, Marie-Lise C
AU - Bouzariouh, Anouar
AU - Stubelius, Ingrid
AU - Kölby, Lars
AU - Lundborg, Christopher
AU - Das, Sumit
AU - Johnson, David
AU - Wall, Steven A
AU - Larysz, Dawid F
AU - Dowgierd, Krzysztof
AU - Koszowska, Małgorzata
AU - Schulz, Matthias
AU - Gratopp, Alexander
AU - Thomale, Ulrich-Wilhelm
AU - Zafra Vallejo, Víctor
AU - Redondo Alamillos, Marta
AU - Ferreras Vega, Rubén
AU - Apolito, Michela
AU - Vergnaud, Estelle
AU - Paternoster, Giovanna
AU - Khonsari, Roman H
AU - ERN CRANIO Workgroup Craniosynostosis
N1 - Publisher Copyright:
Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons.
PY - 2024/12/1
Y1 - 2024/12/1
N2 - Background: Perioperative airway management following midface advancements in children with Apert and Crouzon-Pfeiffer syndromes can be challenging, and protocols often differ. This study examined airway management following midface advancements and postoperative respiratory complications. Methods: A multicenter, retrospective cohort study was performed to obtain information about the timing of extubation, perioperative airway management, and respiratory complications after monobloc or Le Fort III procedures. Results: A total of 275 patients (monobloc surgery, n = 129; Le Fort III surgery, n = 146) were included. Sixty-two patients received immediate extubation and 162 received delayed extubation; 42 had long-term tracheostomies, and 9 had perioperative short-term tracheostomies. In most centers, short-term tracheostomies were reserved for selected cases. Patients with delayed extubation remained intubated for 3 days (interquartile range, 2 to 5 days). The rate of no or only oxygen support after extubation was comparable between immediate and delayed extubation groups (58 of 62 patients [94%] and 137 of 162 patients [85%], respectively). However, the immediate extubation group developed fewer cases of postoperative pneumonia than did the delayed group (0 of 62 [0%] versus 24 of 161 [15%]; P = 0.001). Immediate extubation also appeared safe in moderate to severe obstructive sleep apnea, as 19 of 20 patients (95%) required either no or only oxygen support after extubation. The odds of developing intubation-related complications increased by 21% with every extra day of intubation. Conclusions: Immediate extubation following midface advancements was found to be a safe option, as it was not associated with respiratory insufficiency but did lead to fewer complications. Immediate extubation should be considered routine management in patients with no or mild obstructive sleep apnea, and should be the aim in moderate to severe obstructive sleep apnea cases after careful assessment.
AB - Background: Perioperative airway management following midface advancements in children with Apert and Crouzon-Pfeiffer syndromes can be challenging, and protocols often differ. This study examined airway management following midface advancements and postoperative respiratory complications. Methods: A multicenter, retrospective cohort study was performed to obtain information about the timing of extubation, perioperative airway management, and respiratory complications after monobloc or Le Fort III procedures. Results: A total of 275 patients (monobloc surgery, n = 129; Le Fort III surgery, n = 146) were included. Sixty-two patients received immediate extubation and 162 received delayed extubation; 42 had long-term tracheostomies, and 9 had perioperative short-term tracheostomies. In most centers, short-term tracheostomies were reserved for selected cases. Patients with delayed extubation remained intubated for 3 days (interquartile range, 2 to 5 days). The rate of no or only oxygen support after extubation was comparable between immediate and delayed extubation groups (58 of 62 patients [94%] and 137 of 162 patients [85%], respectively). However, the immediate extubation group developed fewer cases of postoperative pneumonia than did the delayed group (0 of 62 [0%] versus 24 of 161 [15%]; P = 0.001). Immediate extubation also appeared safe in moderate to severe obstructive sleep apnea, as 19 of 20 patients (95%) required either no or only oxygen support after extubation. The odds of developing intubation-related complications increased by 21% with every extra day of intubation. Conclusions: Immediate extubation following midface advancements was found to be a safe option, as it was not associated with respiratory insufficiency but did lead to fewer complications. Immediate extubation should be considered routine management in patients with no or mild obstructive sleep apnea, and should be the aim in moderate to severe obstructive sleep apnea cases after careful assessment.
UR - http://www.scopus.com/inward/record.url?scp=85210545513&partnerID=8YFLogxK
U2 - 10.1097/PRS.0000000000011317
DO - 10.1097/PRS.0000000000011317
M3 - Article
C2 - 38289904
SN - 0032-1052
VL - 154
SP - 1281
EP - 1292
JO - Plastic and Reconstructive Surgery
JF - Plastic and Reconstructive Surgery
IS - 6
ER -