Examining the need for routine intensive care admission after surgical repair of nonsyndromic craniosynostosis: a preliminary analysis

Restricted access


At British Columbia Children’s Hospital (BCCH), pediatric patients with nonsyndromic craniosynostosis are admitted directly to a standard surgical ward after craniosynostosis surgery. This study’s purpose was to investigate the safety of direct ward admission and to examine the rate at which patients were transferred to the intensive care unit (ICU), the cause for the transfer, and any patient characteristics that indicate higher risk for ICU care.


The authors retrospectively reviewed medical records of pediatric patients who underwent single-suture or nonsyndromic craniosynostosis repair from 2011 to 2016 at BCCH. Destination of admission from the operating room (i.e., ward or ICU) and transfer to the ICU from the ward were evaluated. Patient characteristics and operative factors were recorded and analyzed.


One hundred fourteen patients underwent surgery for single-suture or nonsyndromic craniosynostosis. Eighty surgeries were open procedures (cranial vault reconstruction, frontoorbital advancement, extended-strip craniectomy) and 34 were minimally invasive endoscope-assisted craniectomy (EAC). Sutures affected were sagittal in 66 cases (32 open, 34 EAC), coronal in 20 (15 unilateral, 5 bilateral), metopic in 23, and multisuture in 5. Only 5 patients who underwent open procedures (6%) were initially admitted to the ICU from the operating room; the reasons for direct admission were as follows: the suggestion of preoperative elevated intracranial pressure, pain control, older-age patients with large reconstruction sites, or a significant medical comorbidity. Overall, of the 107 patients admitted directly to the ward (75 who underwent an open surgery, 32 who underwent an EAC), none required ICU transfer.


Overall, the findings of this study suggest that patients with nonsyndromic craniosynostosis can be managed safely on the ward and do not require postoperative ICU admission. This could potentially increase cost savings and ICU resource utilization.

ABBREVIATIONS BCCH = British Columbia Children’s Hospital; EAC = endoscope-assisted craniectomy; ICP = intracranial pressure; ICU = intensive care unit.

Article Information

Correspondence Christopher M. Bonfield: Vanderbilt University Medical Center, Nashville, TN. chris.bonfield@vanderbilt.edu.

INCLUDE WHEN CITING Published online September 21, 2018; DOI: 10.3171/2018.6.PEDS18136.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.




Bee TKMagnotti LJCroce MAMaish GOMinard GSchroeppel TJ: Necessity of repeat head CT and ICU monitoring in patients with minimal brain injury. J Trauma 66:101510182009


Bui JQMendis RLvan Gelder JMSheridan MMWright KMJaeger M: Is postoperative intensive care unit admission a prerequisite for elective craniotomy? J Neurosurg 115:123612412011


Gabel BCMartin JCrawford JRLevy M: Questioning the need for ICU level of care in pediatric patients following elective uncomplicated craniotomy for brain tumors. J Neurosurg Pediatr 17:5645682016


Godden DRPatel MBaldwin AWoodwards RT: Need for intensive care after operations for head and neck cancer surgery. Br J Oral Maxillofac Surg 37:5025051999


Goobie SMZurakowski DProctor MRMeara JGMeier PMYoung VJ: Predictors of clinically significant postoperative events after open craniosynostosis surgery. Anesthesiology 122:102110322015


Hecht NSpies CVajkoczy P: Routine intensive care unit-level care after elective craniotomy: time to rethink. World Neurosurg 81:66682014


Mirza FAWang CPittman T: Can patients safely be admitted to a ward after craniotomy for resection of intra-axial brain tumors? Br J Neurosurg 32:2012052018


Ou CHKent SKHammond AMBowen-Roberts TSteinbok PWarren DT: Morphine infusions after pediatric cranial surgery: a retrospective analysis of safety and efficacy. Can J Neurosci Nurs 30:21302008


Pastores SMDakwar JHalpern NA: Costs of critical care medicine. Crit Care Clin 28:110 v2012


Seruya MSauerhammer TMBasci DRogers GFBoyajian MJMyseros JS: Analysis of routine intensive care unit admission following fronto-orbital advancement for craniosynostosis. Plast Reconstr Surg 131:582e588e2013


Warren DTBowen-Roberts TOu CPurdy RSteinbok P: Safety and efficacy of continuous morphine infusions following pediatric cranial surgery in a surgical ward setting. Childs Nerv Syst 26:153515412010


Washington CWGrubb RL Jr: Are routine repeat imaging and intensive care unit admission necessary in mild traumatic brain injury? J Neurosurg 116:5495572012




All Time Past Year Past 30 Days
Abstract Views 86 86 47
Full Text Views 49 49 20
PDF Downloads 64 64 29
EPUB Downloads 0 0 0


Google Scholar