Postoperative complications of elective surgeries in dogs and cats determined by examining electronic and paper medical records

Postoperative complications (POC) that developed in dogs and cats that underwent elective ovariohysterectomy, castration, and declaw at a veterinary teaching hospital were determined by examining the computerized abstracts of the medical records and by examining a random sample of the paper medical records. When the computerized abstracts were examined, POC were found to have occurred in 62 (6.1%) of 1,016 dogs. One dog died and 6 others developed major complications. Postoperative complications were found to have occurred in 38 (2.6%) of 1,459 cats. Two cats died and 1 was euthanatized. Four other cats developed major complications. Complete paper medical records for 218 dogs and cats were examined. When the paper medical records were examined, the proportions of dogs and cats with POC were 19.4% and 12.2%, respectively. These proportions were 4 to 7 times higher than when the computerized abstracts were the data source. Results of this study indicate that the frequency of clinically relevant POC of elective surgeries in dogs and cats is substantial. Examination of the computerized abstracts of medical records at this hospital allowed us to rapidly identify cases that could be included in the study but the frequency of POC would be significantly underestimated if paper records were not also assessed.     

Bronchiolitis obliterans organising pneumonia simulating bronchial carcinoma

OBJECTIVE: The purpose of the study was to identify factors associated with an increased risk of complications after partial-thickness or full-thickness glaucoma surgery. DESIGN: A retrospective, cohort analysis. PARTICIPANTS: A total of 24,206 Medicare patients who were older than 65 years of age and who were enrolled in Medicare in 1994 underwent partial-thickness or full-thickness glaucoma surgical procedures in 1994. INTERVENTION: The authors obtained data on all glaucoma surgery claims to the Health Care Finance Administration in 1994 and analyzed complication rates using hierarchical logistic regression, separately smoothing four sets of regression coefficients (state-level effects, systemic and ocular diagnoses, prior ocular surgeries, and concomitant ocular surgeries). MAIN OUTCOME MEASURE: Patients were classified as having complications if their records showed at least one of the following occurrences after surgery: retinal detachment repair, endophthalmitis, scleral fistula revision-repair, or cyclodestruction. RESULTS: The risk of complications was greater for full-thickness procedures than for partial-thickness procedures (odds ratio [OR] = 1.51; 95% confidence interval [CI] = 1.07, 2.12). Compared to glaucoma surgeries performed without an additional intraocular procedure, glaucoma surgery with prior phacoemulsification (OR = 0.51; 95% CI = 0.35, 0.74) was associated with lower complication rates, as was glaucoma surgery with prior argon laser trabeculoplasty (OR = 0.62; 95% CI = 0.44, 0.88). A concomitant vitrectomy (OR = 1.86, 95% CI = 1.35, 2.56) was associated with greater odds of a complication. The mean follow-up of subjects was 184 days (standard deviation, +/- 107), whereas the mean time to a complication was 49 days (standard deviation, +/- 63). CONCLUSION: The risk of an early postoperative complication after full-thickness procedures appears to be greater than that after partial-thickness procedures. Concomitant intraocular procedures performed in conjunction with glaucoma surgery, such as a vitrectomy, can substantially increase the risk of retinal detachment repair, endophthalmitis, scleral fistula revision-repair, and/or cyclodestruction.     

Elective cervical discectomy in California: postoperative in-hospital complications and their risk factors

STUDY DESIGN: A retrospective cohort study of short-term outcomes after elective cervical discectomy in California hospitals. OBJECTIVES: To compare the frequency of elective cervical discectomy across population strata, to determine the frequency of adverse outcomes in the early postoperative period, and to identify risk factors for such outcomes. SUMMARY OF BACKGROUND DATA: Previous cervical discectomy series have been too small to analyze risk factors for early complications, and have originated from centers that may not adequately represent the population. METHODS: Computerized hospital discharge abstracts were obtained from the California Office of Statewide Health Planning and Development. Inclusion and exclusion criteria were applied to identify 10,416 routine discectomies at 257 hospitals in 1990-1991. Several categories of postoperative complications were identified, along with inpatient deaths, early reoperations, and nursing home transfers. Logistic regression was used to estimate the independent effects of patient characteristics on short-term outcomes. RESULTS: After adjustment for age and gender, blacks were 51% and Hispanics were 24% as likely as whites to undergo elective cervical discectomy. Overall, 6.7% of patients had one or more reported postoperative complications: 1.8% had noninfectious surgical complications, 1.8% had infectious complications, 4.0% had other medical complications, and 0.35% had unplanned reoperations before discharge. Fourteen inpatient deaths were reported (0.13%). Congestive heart failure, alcohol/drug abuse, chronic lung disease, previous spine surgery, psychological disorders, and chronic musculoskeletal disorders were independently associated with postoperative complications. Even after adjustment, risk was higher with advancing age, higher among women than among men, and higher after posterior fusion than after discectomy without fusion. CONCLUSIONS: The ethnic disparity in cervical discectomy rates suggests overuse among whites or underuse among minority populations. The complication rates reported here are similar to those synthesized from previous literature, except that the lower incidence of neurologic complications reflects our inability to distinguish preoperative from postoperative deficits. Important comorbidities should be identified and treated, if appropriate, before cervical spine surgery.     

Functional decoupling of left ventricular beta-adrenoceptor in a canine model of obesity-hypertension]

OBJECTIVE: To determine whether selected preoperative medical, social, or behavioral factors predict the occurrence of cataract wound complications. PATIENTS AND METHODS: Patients who underwent cataract surgery at a Veterans Administration hospital were used in a case-control study. Cases were defined by the occurrence of any postoperative cataract wound gape with or without iris prolapse within 12 weeks of surgery and requiring repair in the operating room. Controls were patients who had no postoperative complications. Two controls were selected for each case patient and matched for surgeon. RESULTS: Thirty-one patients with postoperative wound complications occurred after 2041 cataract extractions (1.5%). Occurrence of wound complications was predicted by previous hematologic disorder (odds ratio, 2.9; 95% confidence interval, 1.1-8.1). Phacoemulsification surgery had a protective effect against wound complication (odds ratio, 0.2; 95% confidence interval, 0.09-0.64). There was no difference in final visual acuity and refractive indexes in patients with and without wound complications (P = .6 by Student t test). CONCLUSIONS: Most medical social and behavioral preoperative factors have limited discriminatory power in predicting who will have postoperative cataract wound complications. The association of previous hematologic disorders to predict the occurrence of wound complications varied with the level of alcohol use. Although this study was not primarily designed to assess the role of surgical technique, phacoemulsification cataract extraction had a statistically significant protective effect against wound complications. Visual outcome in patients with postoperative wound complications is generally very good.     

Chromosome 16 in primary prostate cancer: a microsatellite analysis

OBJECTIVES: To evaluate whether orthotopic urinary diversion is a viable option for patients undergoing cystoprostatectomy for radio-recurrent prostate cancer (RRPC). METHODS: Between 1990 and 1996, we performed 34 salvage surgeries for RRPC, including 26 radical retropubic prostatectomies and 8 cystoprostatectomies. We determined the operative and postoperative complication rates and pathologic stage for the 8 patients undergoing cystoprostatectomy. RESULTS: Of the 8 patients in whom cystoprostatectomy was performed, 5 underwent ileal conduit diversion and 3 underwent orthotopic neobladder reconstruction. There were no intraoperative complications or perioperative mortalities. In the group with orthotopic neobladder, postoperative complications included pyelonephritis in 1 patient and prolonged ileus in another. In the group with ileal conduit, no short-term complications occurred; 1 patient developed an incisional hernia on long-term follow-up. All patients with neobladder reconstruction are continent during the day. One patient wears one pad at night. The other 2 are continent at night. CONCLUSIONS: Orthotopic urinary diversion is a valid option for selected patients with RRPC who require a cystoprostatectomy. This procedure can be performed with minimal complications, resulting in good continence and good quality of life.     

Total hip arthroplasty in patients who have chronic lymphocytic leukemia

Twenty patients who had chronic lymphocytic leukemia underwent 25 elective primary total hip arthroplasties at the Mayo Clinic. No patient had a postoperative prosthetic infection. No patient had an intraoperative or postoperative hemorrhagic complication. One patient had a revision for aseptic loosening. After an average follow-up period of 4.6 years, there were 84% good and excellent results. It is concluded that patients who have early-stage chronic lymphocytic leukemia may not be at increased risk for major perioperative or postoperative complications in total hip arthroplasty. The surgeon must remain vigilant for postoperative complications, but satisfactory clinical results can be obtained in this patient population.     

Comparison of ketorolac and opioid analgesics in postoperative ACL reconstruction outpatient pain control

Pain control is an important postoperative consideration with any surgical procedure. Technological and procedural improvements have contributed to the reduction in both the degree of surgical difficulty and the postsurgical complications associated with intricate surgeries. As a result, certain surgeries have potential for being performed on an outpatient basis, dependent upon appropriate pain-management regimens and the degree of potential for postoperative complications. Arthroscopic anterior cruciate ligament (ACL) reconstruction is a common procedure. Because of the reduction in invasiveness that arthroscopy provides, outpatient surgery is now routinely employed for ACL patients. The arguments against ACL outpatient surgery have included the reluctance to use ambulatory, indwelling, intravenous pain-pump delivery systems for opioid pain medication. The purpose of this study was to determine the efficacy of a ketorolac tromethamine used for the management of the postoperative pain produced as a result of outpatient ACL reconstruction. When the ketorolac pain management regimen is compared in this setting with meperidine or morphine, pain control is as good as, or in some cases better than, either of the opioid drugs. Additionally, the adverse side effects associated with opioid drugs are significantly reduced at a substantially lower direct cost to the patient.     

Outcome of 1000 consecutive clinic- and hospital-based cataract surgeries in a Danish county

PURPOSE: To evaluate the homogeneity and quality of cataract surgery in a Danish county. SETTING: Four private eye clinics and the Department of Ophthalmology, Hiller?d Hospital, Frederiksborg County, Denmark. METHODS: This prospective study comprised 1012 consecutive cases of age-related cataract; 48% of the surgeries were performed in the hospital and 52%, at 1 of 4 clinics. Demographic and clinical data were recorded on standardized data sheets at referral, surgery, and final refraction. Main outcome measures were change in best corrected visual acuity (BCVA), refractive power at final refraction, surgery-related complications, and waiting time for surgery and final refraction. RESULTS: The hospital group had greater dispersion of age (P < .001) and higher frequency of general health problems (P < .005) and glaucoma (P < .01) than the clinic group. Fifty-four percent of surgeries were by phacoemulsification and 46%, by extracapsular cataract extraction (ECCE). In general, phacoemulsification was prevalent at the hospital and ECCE at the clinics. No difference was found between groups in visual acuity at final refraction. Of all patients, 87.1% attained a BCVA of 0.5 or better and of the best cases, 96.2%. Zonule or capsule rupture with or without vitreous loss occurred more often in the hospital group (P < .05), while the incidence of postoperative complications was identical in the 2 groups. One cases of retinal detachment was found. Time from referral to final refraction was shorter at clinics, while waiting time from surgery to final refraction was shorter at the hospital (P < .001). CONCLUSION: Dividing cataract surgery between hospital and private clinics seems to be a satisfactory model for meeting the increasing demand for cataract surgery.     

The value of laparoscopic cholecystectomy in the treatment of gallbladder pathologies]

We have prospectively studied all cholecystectomies performed in one year in our clinic in two groups: 190 cases performed laparoscopically and 98 open. We used standardized records and the EPI 5 program on an IBM compatible computer. There were no significant differences between groups regarding weight, sex and proportion of cases with acute cholecystitis. There were however major differences regarding age, type of habitat, ASA score and association with acute pancreatitis, obstructive jaundice and angiocholitis. Conversion of laparoscopic cholecystectomy to open procedure was imposed in 17 cases (not included in statistical analysis) due to technical difficulties (12 cases), haemorrhagic accidents (6 cases), injury of the common bile duct (1 case), stones lost in the abdominal cavity (3 cases), local peritonitis (5 cases). Laparoscopic cholecystectomy lasted a mean of 74 minutes. We encountered 3 specific complications: one CBD injury recognized intraoperatively and managed by Kehr's procedure (one CBD injury in the open cholecystectomy group), one small bowel perforation and one of biloma. Mortality averaged 0.5% in the LC group (one case of late postoperative stroke considered not related to the procedure) and 1% in the open cholecystectomy group. The hospital admission period was significantly reduced in the LC group (5 days vs. 12 days). LC appears as a safe procedure with a low complication rate. Conversion to open procedure is not a complication. Our study recommend LC as the method of choice in the treatment of gallbladder lithiasis.     

The development of pelviscopic (laparoscopic) surgical procedures in former East Germany--statistics from 1986-1988 inclusive

The fourth German pelviscopy/laparoscopy statistical report includes survey data on a total of 219,314 laparoscopies from 354 clinics and 40,892 laparoscopies from 161 private practices. Clinics' response rate was 44.7%, 98.9% of them reported performing laparoscopies; and the number of serious complications requiring laparotomy or control laparoscopy was 492 (2.2/1,000). For private practices, the comparable figures were 66%, 90.8% and 123 (3/1,000), respectively. Compared with data from the third laparoscopy statistical survey, the data show a slight increase in serious complications, most of which were mechanical lesions of blood vessels in the abdominal wall or in the mesosalpinx, followed by mechanical lesions of the intestine. As shown by the previous survey, 16.5% of the complications were burns. For tubal sterilization, bipolar techniques were still predominant; approximately equal numbers of departments used this method, with or without subsequent transsection of the tubes. Endocoagulation by the method of Semm was the second most popular procedure; the use of clips and rings was of little significance. Monopolar high-frequency (HF) current was still used with transsection by 4.1% of clinics (4.7% of private practices) and without transsection by 2.5% (5.3%). Sterilization failure rates remained the same as those previously reported (2.5/1,000 in clinics, 2.8/1,000 in private practices), the highest rates were observed after the use of monopolar HF techniques. Sixty-six percent of the clinics and 41% of the private practices reported their intention to increase the use of endoscopic operational methods.     

Statistical methods of computing reference values for side-to-side differences in nerve conduction studies

OBJECTIVE: To evaluate the utility of surgery in the treatment of peptic ulcer disease. METHODS: The clinical history of patients operated for peptic ulcer disease in a 15 year period were reviewed. The demographic data, indications for surgery, surgical procedure, morbidity, mortality and long term results, were analyzed. RESULTS: 349 patients were operated for peptic ulcer disease or its complications, 56% male. In 78% surgery was elective, mostly due to pyloric obstruction. In the remaining 22% perforation or bleeding ulcer were the main causes for emergency surgery. The most frequent elective procedure was vagotomy and drainage (66%); in urgent surgery, a definitive procedure was done in 35% of the perforations and in 94% of the bleeding ulcers. The 30-day mortality in urgent surgery was 14%; in elective surgery there was no mortality. A satisfactory long term result was obtained in 80% of the patients. CONCLUSIONS: An indication for surgical treatment of complicated peptic ulcer disease was above 50%, and 90 per cent in recent years. The frequency of urgent surgery is increasing and reached 60% of surgeries for this disease. Whenever possible, a definitive procedure is recommended.     

Penile orthoplasty using dermal grafts in the outpatient setting

OBJECTIVES: To review and evaluate our extensive outpatient experience in the use of dermal grafts for the correction of significant residual chordee in patients requiring penile orthoplasty. METHODS: The medical records of all patients requiring surgical correction for severe penile curvature over the past 5 years were reviewed. Among these, 51 patients were identified in whom dermal grafts were used to correct severe residual chordee. Of these patients, 41 had severe hypospadias, 9 had epispadias, and 1 had urethral atresia. Graft harvest and placement technique, any resulting complications, and parental satisfaction with cosmetic and functional results were all evaluated. RESULTS: The dermal grafts were harvested from the hairless skin of the inguinal area, using one of two techniques. All were used to fill a tunical defect created by incising the tunica at the point of maximal penile curvature. No complications or postoperative hospitalizations resulted from any of the orthoplasty procedures. At a mean follow-up of 27 months, all patients had excellent cosmetic and functional results. CONCLUSIONS: In patients with significant residual chordee, a dermal graft is our preferred method of penile orthoplasty. This technique provides a straight phallus with a very minimal complication rate, it can easily and successfully be performed as an outpatient procedure, and it has assured an excellent cosmetic and functional result.     

Immediate salvage procedure for infected penile prosthesis

PURPOSE: The most devastating complication after the insertion of a penile prosthesis is the development of infection. The standard approach involves removing the entire device, treating intensively with antibiotics and attempting to reinsert a prosthesis at a later date, often with a suboptimal result. Based on the encouraging results of others, during the last 24 months we have used in 2 separate private urological practices a salvage procedure for treatment of infected inflatable penile prostheses. MATERIALS AND METHODS: The protocol used in 7 men with an infected inflatable penile prosthesis included removal of all device components, a 7-step vigorous intraoperative irrigation with 4 different solutions, including vancomycin, immediate reimplantation of a new inflatable penile prosthesis and postoperative outpatient antibiotics with oral ciprofloxacin or intravenous vancomycin or cefazolin. RESULTS: Of the 7 men 6 have experienced excellent results with no infection, minimal morbidity and preservation of penile length. The only failure occurred in a poorly controlled diabetic who required multiple revisions and may have had latent infection for months before it became apparent. CONCLUSIONS: We believe that an immediate salvage procedure for an infected inflatable penile prosthesis is an effective treatment for this difficult complication.     

The fascia lata suburethral sling for treating recurrent urinary stress incontinence

OBJECTIVE: The purpose of this study was to evaluate the effectiveness of the fascia lata suburethral sling procedure in the treatment of recurrent genuine urinary stress incontinence. STUDY DESIGN: This study was a retrospective analysis of 60 patients who had a suburethral fascia lata sling placement between January 1992 and December 1995. Follow-up ranged from 6 months to 3.5 years. The database was obtained by a retrospective chart review, a written questionnaire, and telephone interview. RESULTS: Between January 1992 and December 1995, 72 patients who had at least one previous incontinence procedure were assessed by urodynamic testing and cystourethroscopic examination before undergoing a fascia lata sling placement. Of this population, 60 were available for follow-up. Of this 60, 54, or 90%, had complete cure or marked improvement in the urinary incontinence. There were six failures, two of which had no bladder neck mobility and two of which had detrusor instability and were unable to take medication because of medical contraindications. In addition, two slings were sacrificed because of postoperative complications. The most common postoperative complication was urinary retention, which resulted in eight, or 13.4%, of slings needing to be released. CONCLUSION: Our data support the use of the suburethral fascia lata sling as an effective method for the treatment of recurrent genuine urinary stress incontinence, with urinary retention being the most common postoperative complication.     

A comparative assessment of the results of surgical and conservative treatments in parkinsonism

Late outcomes of surgical and medical treatment of parkinsonism were studied in 582 (including 321 medical and 261 surgical) patients. The follow-up ranged from 6 to 30 years. Three hundred and fifty eight surgeries were performed. In immediate postoperative period, the following results were observed: significant (64%), moderate (20.3%) improvements, no changes (8%), deterioration (3.1%). Late outcomes were as follows: significant (34.9%), moderate (20.3%) improvements, no changes (28.7%), deterioration (16.1%). In surgical patients the complication rate was 14.8%, mortality 0.8%. Analysis of outcomes of surgical and medical treatment showed a statistically significant predominance of good outcomes in surgical patients (34%) as compared with medical ones (14%).     

Study of the pharmacological effect of the bile salt, sodium scymnol sulfate, from Rhizoprionodon acutus. II. Prophylactic effect of scymnol on lesion development in a rat peripheral arterial occlusion model

OBJECTIVE: To determine the rate of late complications following first implantation or elective unit replacement of a permanent pacemaker system. DESIGN: Analysis of pacemaker data and complications prospectively acquired on a computerised database. Complications were studied over an 11 year period from January 1984 to December 1994. SETTING: Tertiary referral cardiothoracic centre. PATIENTS: Records of 2621 patients were analysed retrospectively. MAIN OUTCOME MEASURES: Complications requiring repeat procedures occurring more than six weeks after pacemaker implantation or elective unit replacement. RESULTS: The overall rate of late complications was significantly lower after first implantation of a permanent pacemaker (34 cases, complication rate 1.4%, 95% confidence interval 0.9% to 1.9%) than after elective unit replacement (16 cases, complication rate 6.5% (3.3% to 9.7%). There were 20 cases of erosion, 18 infections, five electrode problems, and seven miscellaneous problems. Complications were more common with inexperienced operators (18.9% (6.0% to 31.8%)) than with experienced operators (0.9% (0.3% to 1.5%). CONCLUSIONS: The incidence of late complications following pacemaker implantation is low and compares favourably with early complication rates. The majority are caused by erosion and infection. Patients who have undergone elective unit replacement are at particular risk.     

Bedside tracheostomy in the intensive care unit

OBJECTIVE: To prove that tracheostomy performed at the bedside in the intensive care unit is a safe, cost-effective procedure. DESIGN: Retrospective review of all adult patients undergoing elective bedside tracheostomy in the intensive care unit between January 1983 and December 1988. Two hundred four patients were identified. SETTING: A private 1200-bed tertiary care center with a 120-bed critical care facility. MAIN OUTCOME MEASURES: Major and minor perioperative complications, cost savings, and comparison of risk between bedside tracheostomy and that performed in the operating room. RESULTS: There were six major complications (2.9%): one death due to tube obstruction, two bleeding episodes requiring reoperation, one tube entrapment requiring operative removal, one nonfatal respiratory arrest, and one bilateral pneumothorax; and seven minor complications (3.4%): five episodes of minor bleeding, one tube dislodgement in a tracheostomy with a well-developed tract, and one episode of mucus plugging. One late complication (tracheal stenosis) was identified. CONCLUSIONS: Bedside tracheostomy in the intensive care unit can be performed with morbidity and mortality rates comparable to operative tracheostomy. In addition, it provides a significant cost savings for the patient.     

Fructosamine in obese normal subjects and type 2 diabetes

Occult coronary artery disease often accompanies symptomatic peripheral vascular disease and has an important effect on survival. Most perioperative and late fatalities after peripheral vascular operations are due to cardiac causes. Noninvasive cardiac testing can identify patients at increased risk for postoperative cardiac complications, although controversy exists regarding the optimal preoperative evaluation. Risk reduction strategies for patients known to be at high risk are also controversial. Some authors advocate coronary revascularization with coronary artery bypass grafting or percutaneous transluminal coronary angioplasty before the vascular procedure. Others believe that the combined morbidity and mortality of 2 operations exceed those of a peripheral vascular operation performed with aggressive monitoring and medical therapy. Continuous electrocardiographic monitoring after an operation has identified silent myocardial ischemia as a powerful predictor of cardiac complications. Ongoing research is likely to provide insights into the pathogenesis of postoperative cardiac complications and may lead to specific therapeutic interventions. Few prospective studies have been done in this area, and the threshold for preoperative and postoperative intervention is unknown. I review the literature and present an algorithm to guide cardiac testing and risk reduction in patients undergoing elective vascular surgical procedures.     

Role of kinins in basal and furosemide-stimulated renin secretion

OBJECTIVE: To determine risk factors predictive of outcomes to aid in the cost-effective preoperative evaluation and postoperative management of patients who are undergoing tonsillectomy and adenoidectomy for obstructed breathing during sleep. DESIGN: A historical cohort study with a nested case-control analysis that examined risk factors associated with postoperative respiratory complications. SETTING: Children's Medical Center of Dallas, Dallas, Tex, which is a pediatric referral hospital for secondary and tertiary pediatric care with both private and university-appointed physicians. PATIENTS: A convenience sample of 355 patients who were undergoing tonsillectomy and adenoidectomy for obstructed breathing during sleep throughout a 1-year period. INTERVENTION: None. MAIN OUTCOME MEASURE: The occurrence of postoperative complications, including airway obstruction, apneas with oxygen desaturations, airway interventions (e.g., endotracheal intubation), or administration of supplemental oxygen, as they related to associated medical conditions (e.g., cerebral palsy or prematurity) and diagnostic tests (e.g., chest x-ray film and electrocardiogram). RESULTS: Five associated medical conditions (cerebral palsy; seizures; age, < or = 3 years; congenital heart disease; and prematurity) were identified as important predictors of a complicated postoperative course using stepwise logistic regression analysis. Those children with an abnormal chest x-ray film or electrocardiogram were also identified as having an associated medical condition that was predictive of postoperative complications. CONCLUSIONS: Children with 1 or more of the associated risk factors identified should be considered candidates for postoperative inpatient observation. A preoperative chest x-ray film and electrocardiogram were found to be of little predictive value, and they are probably not cost-effective screening tests for postoperative respiratory complications.     

Nonsyndromal craniosynostosis: longitudinal outcome following cranio-orbital reconstruction in infancy

This paper presents a prospective longitudinal outcome study on patients with nonsyndromal craniosynostosis who were treated with the contemporary craniofacial surgical techniques of suture release, cranial decompression, and cranial and orbital reconstruction and reshaping in infancy. Diagnosis, surgical treatment, and long-term results and complications are reviewed. Preoperative and long-term postoperative intracranial volumes in these patients were evaluated and compared with age and gender match controls throughout the period of the study. From July 1, 1990, to July 1, 1994, 25 patients with isolated nonsyndromal craniosynostosis underwent surgery of the deformity. Eight patients were excluded from the study based on incomplete postoperative computed tomography (CT) records. Of the 17 patients with long-term computerized records, 11 were boys and 6 were girls. The nonsyndromal craniosynostosis patients in this study include six with bilateral coronal craniosynostosis, six with unilateral coronal craniosynostosis, four with sagittal craniosynostosis, and one with metopic craniosynostosis. The average age at the time of surgery for all patients was 9 months, and the average age at the time of the latest follow-up CT scan for all patients in the study was 3.5 years. There were no perioperative complications in this series of patients including no bleeding, no infection, no wound healing complications, and no mortality. Bony fixation included a combination of wire osteosynthesis and rigid microfixation. All patients had only one surgical procedure for the correction of their deformity. Evaluation of both preoperative and long-term postoperative intracranial volume measurements in this series of patients revealed that these volume measurements were comparable with the gender match control groups at all ages throughout the study. The significance of these findings for this longitudinal outcome study is discussed.