Predisposing Factors for Postoperative Complications in the Year following Frontoorbital Advancement and Remodeling: A Single-Institution Study of 267 Patients

Background: Frontoorbital advancement and remodeling (FOAR) is a common surgical approach used for craniosynostosis, conferring functional and aesthetic benefit. There are few reports examining predisposing factors for postoperative complications within the first year after surgery. This study aimed to establish complication rates and identify risk factors for inferior outcomes in a large population of patients undergoing FOAR. Methods: All patients who underwent FOAR from 2013 through 2022 at the authors' institution were retrospectively studied. Perioperative and postoperative data were collected to yield outcomes analyses. Multivariable logistic regression with backward selection was performed to identify predictors of postoperative complications. Results: A total of 267 patients underwent FOAR. The overall complication rate was 14.2%, most commonly delayed wound healing (7.4%), postoperative blood transfusion (5.8%), and infection requiring readmission (1.9%). Tense closure independently predicted delayed wound healing (P < 0.001) and infection requiring readmission (P = 0.03). Syndromic patients were more likely than nonsyndromic patients to have undergone previous craniofacial surgery (45.3% versus 23.8%; P = 0.003). Syndromic status and previous craniofacial surgery were associated with increased risk of developing infection requiring readmission (P = 0.012 and P = 0.004, respectively). A greater proportion of malnourished patients experienced postoperative complications compared with patients without malnourishment (24.4% versus 12.1%; P = 0.031), although there were no significant differences in individual postoperative outcomes. Conclusions: Identified risk factors for complications included syndromic status, tense closure, and previous craniofacial surgery. Most complications were managed nonoperatively. These factors may be considered in preoperative planning and when counseling families. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.