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Hospital Variation and Resource Use for Infants with Craniosynostosis Undergoing Open, Endoscopic, and Distraction
Melissa D Kanack1,2, Mark R Proctor2,3, John G Meara1,2
1Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA.
Insights
Surgical techniques for craniosynostosis vary significantly across hospitals and regions. Endoscopic repair without distraction is the least resource-intensive, while open repair with distraction is the most resource-intensive.
Area of Science:
- Pediatric Surgery
- Craniofacial Surgery
- Health Services Research
Background:
- Craniosynostosis treatment involves endoscopic, open, and distraction surgical techniques.
- Significant institutional variation exists in the application of these surgical methods.
- Hospital resource utilization associated with different techniques has not been fully elucidated.
Purpose of the Study:
- To assess institutional variation in surgical technique selection for craniosynostosis.
- To compare hospital resource use across different surgical approaches for craniosynostosis.
Main Methods:
- Retrospective analysis of 5249 infants (<18 months) undergoing craniosynostosis surgery from 2016-2020.
- Data sourced from 39 freestanding children's hospitals in the Pediatric Health Information System (PHIS) database.
- Surgical types (endoscopic vs. open, with/without distraction) identified via ICD-10-CM codes; inpatient cost and length of stay (LOS) compared using Wilcoxon Rank Sum test.
Main Results:
- Significant variation (p < .001) in endoscopic repair rates across hospitals (median 23.6%, range 0%-80.4%) and regions.
- Endoscopic repair without distraction had lower median LOS (1 day) and cost ($14,617) compared to with distraction (2 days, $33,599).
- Open repair without distraction had lower median LOS (3 days) and cost ($37,251) compared to with distraction (5 days, $62,247).
Conclusions:
- Substantial variation in surgical approach for craniosynostosis exists across hospitals and regions.
- Endoscopic repair without distraction demonstrated the lowest hospital resource utilization.
- Open repair with distraction exhibited the highest hospital resource utilization, necessitating further outcome and cost-effectiveness analyses.
Abstract:
BackgroundCraniosynostosis is treated with endoscopic, open, and/or distraction surgical techniques. We assessed institutional variation in the use these techniques for craniosynostosis and compared hospital resource use.MethodsRetrospective analysis of 5249 infants age <18 months old undergoing surgical procedures for all types of craniosynostosis in 2016-2020 in 39 freestanding children's hospitals in the Pediatric Health Information System (PHIS) database. Endoscopic vs. open cranial vault surgery (with and without distraction osteogenesis) was identified using ICD-10-CM codes. Inpatient cost and length of stay (LOS) were compared by surgery type with Wilcoxon Rank Sum.ResultsThere was significant (p < .001) variation in the percentage of infants who underwent endoscopic repair across hospitals [median 23.6% (interquartile range (IQR): 7.6%-37.5%), range: 0% to 80.4%] and across regions [range: 22.1% (southeast) to 42.5% (northeast)]. For endoscopic procedures, median LOS and inpatient cost were lower (p < .001) without vs. with distraction [1 day (IQR 1-1) vs. 2 days (IQR 2-2); $14,617 (IQR 11,823-22178) vs. $33,599 (IQR 22,800-38,619)]. For open interventions, median LOS and inpatient cost were also lower (p < .001) without vs. with distraction [3 days (IQR 2-4) vs. 5 days (IQR 4-6) and $37,251 (IQR 27,114-50.320) vs. $62,247 (IQR 42,124-91,620)].ConclusionsSubstantial variation in the surgical approach for craniosynostosis exists across hospitals and regions. Endoscopic repair without distraction had the lowest hospital resource use, while open repair with distraction had the highest hospital resource. Subsequent analysis of short- and long-term outcomes as well as patient-and-family costs is necessary to assess the true cost-effectiveness of each approach.
