Association of Preoperative Nutritional Status With Outcomes in Fronto-Orbital Advancement for Syndromic Craniosynostosis

Raina K. Patel, Research Fellow, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA; Medical Student, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, FL.
Asli Pekcan, Research Fellow, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA; Medical Student, Division of Plastic and Reconstructive Surgery, Keck School of Medicine, Los Angeles, CA.
Valeria Mejia, Research Fellow, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA; Medical Student, Division of Plastic and Reconstructive Surgery, Keck School of Medicine, Los Angeles, CA.
Melanie Bakovic, Research Fellow, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA; Medical Student, The George Washington University School of Medicine and Health Sciences, Washington, DC.
Alyssa Valenti, Craniofacial Fellow, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA.
Mark M. Urata, Professor, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA; Professor, Division of Plastic and Reconstructive Surgery, Keck School of Medicine, Los Angeles, CA; Professor, Division of Oral and Maxillofacial Surgery, Keck School of Medicine, Los Angeles, CA.
Jeffrey A. Hammoudeh, Professor, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA; Professor, Division of Plastic and Reconstructive Surgery, Keck School of Medicine, Los Angeles, CA; Professor, Division of Oral and Maxillofacial Surgery, Keck School of Medicine, Los Angeles, CA. Electronic address: JHammoudeh@chla.usc.edu.

Document Type

Journal Article

Publication Date

10-1-2025

Journal

Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons

Volume

83

Issue

10

DOI

10.1016/j.joms.2025.06.027

Abstract

BACKGROUND: Calvarial vault remodeling (CVR) is a critical procedure for patients with syndromic craniosynostosis (SC), a condition associated with genetic syndromes and comorbidities that can worsen nutritional status before surgery. Despite nutritional challenges in this population, few studies have assessed how preoperative nutritional health correlates with complications, relapse, or hospital stay after CVR. PURPOSE: The study purpose was to measure the association of nutritional status on surgical outcomes in patients with SC undergoing CVR. STUDY DESIGN, SETTING, SAMPLE: This study was a retrospective cohort analysis of pediatric subjects with SC who underwent CVR between 2002 and 2024 at a children's hospital in Los Angeles. Patients surgically treated at external hospitals were excluded. PREDICTOR VARIABLE: The primary predictor variable was nutritional status, measured using weight-for-length (WFL) percentile, with higher values indicating better nutritional status. Gastrostomy tube (G-tube) dependency and preoperative serum albumin were included as secondary predictors. MAIN OUTCOME VARIABLE(S): The primary outcome was the occurrence of postoperative complications, including hematomas, unplanned reoperation, and skeletal relapse. Secondary outcomes included length of stay, readmissions, and mortality. COVARIATES: The covariates were demographics (age, sex, and prematurity) and surgical parameters (anesthesia time and blood transfusions). ANALYSES: Statistical analyses included χ tests, analysis of variance, t-tests, and regression analyses to assess the relationships between nutritional status and outcome variables. A P value of < 0.05 was considered statistically significant. RESULTS: The study included 86 patients (mean age 12.4 ± 10.9 months); 14% (n = 12) were premature and 21% (n = 18) were G-tube dependent. G-tube dependent patients had significantly lower WFL percentiles compared to those without G-tubes (26.4 vs 43.5, P < .001). Lower WFL scores were significantly associated with higher rates of postoperative complications (P = .047). Regression analysis showed that for every 10-point increase in WFL percentile, the predicted probability of complications decreased by 6.5% (P < .001). CONCLUSIONS AND RELEVANCE: Low WFL and G-tube dependency were statistically significantly associated with a higher rate of postoperative complications in patients with SC undergoing CVR. These findings suggest that careful assessment and optimization of preoperative nutritional status may help reduce the risk of complications and improve patient outcomes.

Department

School of Medicine and Health Sciences Student Works

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