Clinical Protocol and 15 Year Safety Experience Caring for Postoperative Craniosynostosis Patients on the Ward

ackground: At Rady Children's Hospital in San Diego, we routinely care for postoperative craniosynostosis patients in the regular ward. This is a departure from international norms; in most craniofacial centers these children are cared for postoperatively in Intensive Care Units (ICUs). In the context of increasingly value driven healthcare, where each dollar spent is scrutinized for effectiveness, our experience shows that a less resource expensive postop setting for appropriately selected craniosynostosis patients is safe and effective.

Purpose: As part of our ongoing commitment to the highest quality of care in craniofacial surgery, we recently reviewed our protocol for postoperative care of craniosynostosis patients. We present safety outcomes for 63 patients here and report our experience with a clinical protocol for postoperative surgical care of craniosynostosis patients (open and endoscopic) in the regular ward.

Methods and Materials: Retrospective chart review identified 63 patients undergoing intracranial surgery for a craniosynostosis diagnosis in the last 18 months at Rady Childrens Hospital (open intracranial surgery=44 and endoscopic=19.) Patients undergoing onlay cranioplasty or minor procedures were excluded.

Results: 63 patients total were identified; 52 patients were managed postoperatively in the ward and 11 patients were planned admissions to the ICU, because of concomitant medical comorbidties (including significant heart disease, apnea or neuroendocrine disorders) or magnitude of intervention (including facial bipartition, Lefort 3 osteotomies, monobloc advancement or macrocephaly reduction for congenital hydrocephalus). No patients initially managed on the floor required transfer to the ICU. No adverse events or deaths occurred. Our specific protocol for managing craniosynostosis patients in the ward (including telemetry and timing of postoperative hematocrit checks) will be reviewed in the presentation.

Conclusions: Postoperative surgical care of appropriately selected craniosynostosis patients in the regular ward is safe and effective, as indicated by our review of 63 patients. Because escalation of care is rarely required, we are performing a complete review of our 15 year experience with 700 patients using this unique clinical protocol.