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Published on: August 11, 2015
Trends in Open Versus Minimally Invasive Craniosynostosis Repair: A 10-Year National Analysis
Ethan Fung1, Bernice Z Yu1, Jacquelyn M Roth1
1Division of Plastic and Reconstructive Surgery.
Insights
Minimally invasive surgery (MIS) for craniosynostosis repair increased over 10 years, showing reduced complications and shorter stays. Access to MIS has expanded for diverse patient groups, though improvements are still needed.
Area of Science:
- Pediatric surgery
- Craniofacial surgery
- Surgical quality improvement
Background:
- Cranial vault reconstruction for craniosynostosis has seen a shift towards minimally invasive surgery (MIS).
- Understanding trends in surgical approaches and outcomes is crucial for optimizing patient care.
Purpose of the Study:
- To identify trends in surgical approaches for craniosynostosis repair over the past decade.
- To analyze demographic and surgical outcome differences between open surgery (OS) and minimally invasive surgery (MIS).
Main Methods:
- Analysis of the National Surgical Quality Improvement Program-Pediatrics database (2013-2022).
- Inclusion of 12,104 patients undergoing cranial vault repair for craniosynostosis.
- Trend analysis using linear regression and logistic regression for predictors of MIS.
Main Results:
- The use of MIS increased from 3% to 9% between 2013 and 2022, while OS rates decreased.
- MIS patients were younger, predominantly White, and experienced fewer complications, shorter operative times, and reduced length of stay.
- Significant improvements in MIS access were observed for Hispanic patients, and complication rates decreased in the OS group.
Conclusions:
- Minimally invasive surgery (MIS) for craniosynostosis repair has grown in prevalence over the last decade.
- MIS offers significant benefits including reduced complications, shorter operative and anesthesia durations, and decreased length of stay.
- While access to MIS has broadened for diverse patient populations, further improvements in equitable access and outcomes are warranted.
Objective:
Techniques for cranial vault reconstruction for craniosynostosis have increasingly shifted towards minimally invasive methods. The present study sought to identify trends in surgical approaches based on demographics and surgical outcomes over the past decade.
Methods:
The National Surgical Quality Improvement Program-Pediatrics was queried to identify patients with craniosynostosis who underwent cranial vault repair between January 2013 to December 2022. Patient demographics, surgical characteristics, and postoperative outcomes were gathered for both open surgery (OS) and minimally invasive surgery (MIS) groups per year. Trend analysis was performed by linear regression and predictors for MIS were identified using univariable statistics and multivariable logistic regressions.
Results:
Among 12,104 patients identified, OS rates decreased from 96% to 91%, while the use of MIS increased from 3% to 9% ( P <0.001). MIS patients were younger, primarily White, and had fewer comorbidities, overall complications, blood transfusions, shorter operative time, anesthesia duration, and length of stay ( P <0.001). From 2013 to 2022, the number of overall complications, operative time, and length of stay significantly decreased in the OS group, while the number of patients with comorbidities increased in the MIS group ( P <0.001). Importantly, access to MIS for Hispanic patients improved significantly ( P <0.001).
Conclusion:
The prevalence of MIS for craniosynostosis repair increased over a 10-year period. MIS patients benefit from reduced complication rates, operative time, anesthesia duration, and length of stay. As MIS becomes a more common treatment modality for craniosynostosis, access has expanded to include more complex and diverse patients, though opportunities for improvement still remain.
