National Trends in Practice Patterns Among Neurosurgeons and Plastic Surgeons in Craniosynostosis Repair

Neurosurgery and plastic surgery are the 2 primary specialties that are involved in craniosynostosis repair. This study incorporates a large national surgical database with new diagnostic codes stratifying for suture involvement to investigate practice patterns in craniosynostosis repair depending on specialty.

Patients who were receiving surgical repair for craniosynostosis with specified suture involvement were identified in the 2023 to 2024 National Surgical Quality Improvement Program (NSQIP) pediatric database. Multivariable logistic regression models were used to assess predictors of primary surgical specialty, as well as the impact of specialty on postoperative outcomes (P<0.05).

The final cohort included 1607 patients who were operated by neurosurgery (908, 56.5%) or plastic surgery (699, 43.5%). Higher ASA class (OR: 1.51, 95% CI: 1.10-2.07, P=0.012) was associated with higher odds of plastic surgery involvement, as well as metopic, unicoronal, lambdoid, or multisuture involvement when compared with isolated sagittal involvement (P<0.01). When controlled for age, ASA class, suture type, surgical approach, and operative time, surgical specialty was not significantly associated with all complications (OR 1.05, 95% CI: 0.59-1.88, P=0.87) or perioperative blood transfusion (OR: 1.25, 95% CI: 0.98-1.58, P=0.069).

Plastic surgery is more likely to be the primary surgical team on cases with higher craniosynostosis severity and more severe comorbidity burden, whereas neurosurgery is more likely to be the primary team with isolated sagittal involvement. When controlled for preoperative and surgical factors, primary surgical team was not a predictor of postoperative complications or transfusion.