Public Insurance Is Associated With Increased Emergency Visits After Craniosynostosis Surgery

Postoperative emergency department (ED) visits are common across various procedures, often due to surgical complications, pain, and patient uncertainty about normal surgical recovery. While issues such as infections or dehiscence require acute medical management in the ED setting, many visit reasons are driven by manageable postoperative symptoms like fever or swelling. In this study, we aim to identify the most common reasons for acute care visits within 30 d following craniosynostosis surgery, as to inform postoperative care and address health-care utilization.

A retrospective chart review of patients who underwent surgical repair of craniosynostosis at a tertiary children's hospital between 2003 and 2023 was performed. Patients with incomplete documentation and those lost to follow-up were excluded. The primary outcome was incidence of ED visits within a 30-d period after surgery. Secondary outcomes included duration until ED visit and specific reasons for the visits.

Among 794 patients who underwent surgical craniosynostosis repair, 38 (4.8%) required hospital-based acute care in the ED within 30 d postoperatively. The mean patient age was 9.0 ± 3.4 months, with the majority being male (n = 25, 65.8%). All patients underwent calvarial vault remodeling, with 13 (34.2%) who additionally had fronto-orbital advancement. The median time from surgery to ED visit was 9.5 ± 7.7 days. The most common reasons included fever (8 visits, 21%), vomiting (7 visits, 18%), swelling (6 visits, 16%), and surgical site issues such as drainage, redness, or infection (6 visits, 16%). Other indications included surgical site bleeding (2 visits, 5%), trauma (2 visits, 5%), suture check (1 visit, 2.6%), ear pain (1 visit, 2.6%), seizure (1 visit, 2.6%), and upper respiratory tract viral illness (1 visit, 2.6%). There was a higher proportion of patients with public insurance compared to private insurance in the ED cohort versus those with no ED visits (P = 0.011).

Fever, vomiting, and surgical site concerns are the primary drivers of ED visits after discharge from craniosynostosis surgery. Specific measures, such as providing caregivers with a clear postoperative fever management algorithm, educating families on recognizing normal versus abnormal vomiting, and scheduling early follow-up visits could potentially reduce avoidable ED visits.