If you'd please take your seats. Welcome to the scientific section four on pediatrics. I'd like to welcome our first speaker. This is Dr. Greenan, the need for intensive care, unit level care in patients undergoing craniosynostosis surgery. Hi, everybody. Just wanted to welcome you. Thanks for giving me the opportunity to present. My name's Krista Greenan, and I'm the current fellow at University of Colorado. And I'm here to present the need for ICU level care in patients undergoing craniosynostosis surgery. So I think most of us would agree that we typically send these patients to the ICU after uncomplicated surgery for craniosynostosis. Reasons for this can include blood transfusions, lab work that needs to be done frequently. It can't be necessarily done on the floor. Also, I know in some centers, they actually can't even have opiates on the floor in a pediatric population. However, at the Children's Hospital in Colorado, patients have been routinely sent to the PACU and then the floor for several years. This has been looked at before. This paper by Gooby et al looked at sort of perioperative care for open craniosynostosis surgery. And they identified a low-risk cohort of about 70% of their patient population that could safely be managed on the floor without any sort of ICU interventions. So we did a single-site retrospective chart review of all patients who underwent craniosynostosis surgery between 2009 and 2017. And our primary outcome was unplanned transfer from the floor to an intensive care unit. So a little bit about our cohort. We had 420 patients. The average age was 10.6 months. Our population was more male, at 70% male. And we did include syndromic patients, which made up 10% of our cohort. The syndromes treated were the usual suspects, aperts, cruzons, and several other syndromes and a couple others that were undefined syndromes. Sutures involved, most of our patients had isolated sagittal synostosis. We did have a fair number of other types of synostosis, as well as 8% of our cohort, which had a multisuture synostosis. The types of surgery, as you all know, craniosynostosis surgery is as much art as it is science. And so it's hard to fit all of them into boxes. But we did have, a lot of our cases were sagittal craniectomy with biparietal morcellation, which made up 42.6% of our cohort. Seven percent of our cases involved cranial distractors. No cranial springs were used. And only five of our cases, or 1% of our cohort, was endoscopic, which I think is probably significantly lower than most. And this reflects both the referral pattern at the University of Colorado, as well as institutional bias. At this point, that's sort of changing, and we are doing more of those types of cases. But due to our geography, we have patients coming from far away, and getting helmets refit every couple of months is not necessarily ideal for people that live four to 12 hours away. So postoperatively, we admitted 87% of our cohort to the floor, and those 87% stayed on the floor. We had two patients that were initially admitted to the floor that then got transferred to the ICU. One of these patients was having respiratory distress, likely from over sedation, and he spent one night in the unit with a nasal trumpet, and then was transferred to the floor the next day. And a second patient, who had hyponatremia, and was having seizures, required intubation. 12% of our cohort did get admitted to the ICU postoperatively. That was determined either preoperatively due to comorbidity, or intraoperatively with complications, either from an anesthetic or surgical standpoint. So in conclusion, patients with craniosynostosis, including those with craniofacial syndromes, and those undergoing open surgery, can be safely managed on the floor postoperatively. Factors that can contribute to this are, we are a higher volume center. We've got a multidisciplinary team. So these patients are being visited by multiple residents, fellows, and attendings from different services. And we have a dedicated neurosurgery floor with nurses that are trained in more complex neurosurgical care, including EVDs and lumbar drains. So I'd like to say thank you to Drs. Winston, Wilkinson, and French, who are sort of the leaders of our craniofacial team. And the rest of the people at the Children's Hospital. Any questions? We'll have questions in just a second. Okay. Thank you.

Dr. Krista Greenan

University of Colorado

ICU level care

craniosynostosis surgery

Children's Hospital in Colorado