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Nationwide Perioperative Analysis of Endoscopic Versus Open Surgery for Craniosynostosis: Equal Access, Unequal
Danielle H Rochlin1, Clifford C Sheckter, Hermann Peter Lorenz
1Division of Plastic and Reconstructive Surgery, Stanford University, Palo Alto, CA.
Insights
Endoscopic surgery for craniosynostosis offers benefits over open surgery, including fewer transfusions, shorter hospital stays, and lower costs, without increasing complications. Racial, socioeconomic, and geographic factors did not influence treatment type or outcomes.
Area of Science:
- Pediatric Surgery
- Neurosurgery
- Health Services Research
Background:
- Craniosynostosis treatment involves surgical correction, with options including open surgery and endoscopic approaches.
- Understanding national variations in treatment and outcomes is crucial for optimizing care.
Purpose of the Study:
- To evaluate national differences in inpatient outcomes for endoscopic versus open surgery for craniosynostosis.
- To identify predictors of treatment type, considering racial, socioeconomic, and geographic factors.
Main Methods:
- Analysis of the 2016 Kids' Inpatient Database for patients aged 3 years or younger undergoing craniectomy for craniosynostosis.
- Multivariable regression modeling to assess treatment type predictors and patient outcomes.
Main Results:
- Endoscopic repair was associated with a lower risk of transfusion, shorter length of stay, and reduced hospital costs compared to open repair.
- Older age and syndromic status were predictors for undergoing open repair.
- Inpatient complications did not significantly differ between the two surgical approaches.
Conclusions:
- Endoscopic surgery for craniosynostosis demonstrates clear advantages in terms of reduced resource utilization and shorter hospital stays.
- Racial, socioeconomic, and geographic factors were not found to be significant predictors of treatment choice or surgical outcomes in this national dataset.
- Further research is warranted to explore the impact of these demographic variables on access to craniofacial care.
Abstract:
The purpose of this study is to evaluate national differences in inpatient outcomes and predictors of treatment type for endoscopic versus open surgery for craniosynostosis, with particular consideration of racial, socioeconomic, and geographic factors. The 2016 Kids' Inpatient Database was queried to identify patients aged 3 years or younger who underwent craniectomy for craniosynostosis. Multivariable regression modeled treatment type based on patient-level (gender, race, income, comorbidities, payer) and facility-level (bed size, region, teaching status) variables, and was used to assess outcomes. The weighted sample included 474 patients, of whom 81.9% (N = 388) of patients underwent open repair and 18.1% (N = 86) underwent endoscopic repair. A total of 81.1% of patients were under 1 year of age and 12.0% were syndromic. Patients were more likely to be treated open if they were older (odds ratio [OR] 3.07, P = 0.005) or syndromic (OR 8.56, P = 0.029). Patients who underwent open repair were more likely to receive transfusions (OR 2.86, P = 0.021), and have longer lengths of stay (OR 1.02, P < 0.001) and more costly hospitalizations (OR 5228.78, P = 0.018). Complications did not significantly vary between procedure type. The authors conclude that United States national data confirm benefits of endoscopic surgery, including a lower risk of transfusion, shorter hospital stay, and lower hospital costs, without a significant change in the rate of inpatient complications. Racial, socioeconomic, and geographic factors were not significantly associated with treatment type or perioperative surgical outcomes. Future studies are needed to further investigate the influence of such variables on access to craniofacial care.
