A European multicenter outcome study on the different perioperative airway management policies following midface surgery in syndromic craniosynostosis: a proposal for a Standard Operating Procedure

Iris E Cuperus*, Irene M J Mathijssen, Marie-Lise C van Veelen, Anouar Bouzariouh, Ingrid Stubelius, Lars Kölby, Christopher Lundborg, Sumit Das, David Johnson, Steven A Wall, Dawid F Larysz, Krzysztof Dowgierd, Małgorzata Koszowska, Matthias Schulz, Alexander Gratopp, Ulrich-Wilhelm Thomale, Víctor Zafra Vallejo, Marta Redondo Alamillos, Rubén Ferreras Vega, Michela ApolitoEstelle Vergnaud, Giovanna Paternoster, Roman H Khonsari, ERN CRANIO Workgroup Craniosynostosis

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

BACKGROUND: 

Perioperative airway management following midface advancements in children with Apert and Crouzon/Pfeiffer syndrome 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 / le Fort III procedures.

RESULTS: 

Ultimately, 275 patients (129 monobloc and 146 Le Fort III) were included; 62 received immediate extubation and 162 delayed extubation; 42 had long-term tracheostomies and nine perioperative short-term tracheostomies. Short-term tracheostomies were in most centers reserved for selected cases. Patients with delayed extubation remained intubated for three days (IQR 2 - 5). The rate of no or only oxygen support after extubation was comparable between patients with immediate and delayed extubation, 58/62 (94%) and 137/162 (85%) patients, respectively. However, patients with immediate extubation developed less postoperative pneumonia than those with delayed, 0/62 (0%) versus 24/161 (15%) (P = 0.001), respectively. Immediate extubation also appeared safe in moderate/severe OSA since 19/20 (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/mild OSA and should be the aim in moderate/severe OSA after careful assessment.

Original languageEnglish
JournalPlastic and Reconstructive Surgery
DOIs
Publication statusE-pub ahead of print - 30 Jan 2024

Bibliographical note

Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

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