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Long-Term Risk Factors for Reoperation Following Surgical Treatment of Single-Suture Craniosynostosis
Jessica Blum1*, Garrett Rupp1*, Alvin Wong2, Emily Ewing2, George Kamel1,2, Amanda Gosman1,2 1University of California San Diego, San Diego, CA 2Rady Children's Hospital San Diego, San Diego, CA *Indicates shared first authorship

Background: Previous studies have investigated the natural evolution of reossification after primary craniosynostosis (CS) repair and the need for reoperation to correct the defects in single suture, non-syndromic synostoses. In this study, we investigate the natural history of reossification after surgical craniosynostosis repair in single and multisuture synostoses and identify demographic and perioperative variables that correlate with need for reoperation.

Methods: All patients who underwent open cranial vault reconstruction (OCVR), endoscopic repair, or distraction osteogenesis (DO) for single-suture craniosynostosis from 2000-2019 at our institution were retrospectively reviewed. Demographic information, clinically palpable defects, and need and indication for reoperation were recorded from patient charts. Correlation analyses were used to identify significant associations between patient characteristics or perioperative variables and unplanned reoperation.

Results: Baseline characteristics are listed in Table 1. 605 patients underwent craniosynostosis repair, of whom 313 underwent OCVR, 260 underwent endoscopic repair, and 32 underwent DO. The average age at the time of initial operation was 12.72 months (SD = 18.81 months) and for any reoperation was 4.32 years (SD = 2.99 years). Clinically appreciable cranial defects were detected an average of 1.1 years post initial operation and were noted in 36.1% of open (n=113), 35.0% (n= 91) of endoscopic, and 50.0% (n=16) of DO patients. OCVR for unicoronal (n = 28, 36.8%) metopic (n = 26, 23.6%), and unilateral lambdoid (n = 3, 25%) craniosynostosis were most commonly associated with the need for unplanned reoperation of any kind. Predictive factors for reoperation varied by group, with metopic open patient reoperation most significantly associated with decreased initial surgery time (r = -.24, p = 0.009), metopic endoscopic associated with post op infections/complications (r = .42, p < 0.05), sagittal open associated with decreased initial surgery time (r = -0.33, p < 0.001), and sagittal endoscopic independently associated with hospital length of stay (r = .34, p < 0.001) and respiratory failure (r = .37, p < 0.001). For multi-suture patients, post op complications including seizures and respiratory failure were significantly associated with reoperation requirement (r = .56, p < 0.001).

Conclusion: The incidence of reoperation was lowest following DO for any type of craniosynostosis, and highest in the unicoronal, metopic, and unilateral lambdoid OCVR groups. The average time between operation and appearance of clinically appreciable defects was 1.1 years and the average interval to reoperation was 3.36 years. There are a variety of perioperative factors which help predict reoperative need, which should be used to counsel families weighing options for surgical treatment of craniosynostosis.

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