What is the impact of age at surgery on perioperative medical care in sagittal craniosynostosis ?

Choice of timing for surgical correction of scaphocephaly varies considerably from one surgeon to another. We evaluated the impact of age at the time of surgery on blood loss and transfusion, and length of stay in hospital. We compared 2 homogeneous populations of children operated on by the same surgeon between 2011 and 2021. Younger patients (group 1, under 6 months of age, n = 60) underwent a "H-shaped" 5 cm craniectomy between the coronal and lambdoid sutures. Older patients (group 2, aged over 7 months, n = 34) had a cranial vault remodeling with frontal and parietal translation of craniotomies. The mean durations of anesthesia and surgery were significantly lower in the group 1 (p < 0.0001). The proportion of patients transfused was twice as high in group 2 (p < 0.0001). The median volume of packed erythrocytes transfusion and the median estimated blood volume lost were also significantly greater in group 2 (p < 0.0001). Median lengths of stay in hospital and in the intensive care unit did not differ between the two groups. Early surgery before 6 months of age has many advantages. It allows faster surgical procedures, and reduces intraoperative blood loss and need for transfusion.