A Retrospective Analysis of the Impact of Health Disparities on Treatment for Single Suture Craniosynostosis Before and During the Pandemic

Abstract

Candidates for endoscopic treatment for craniosynostosis must be less than 6 months old. Given the narrow window of eligibility, there is potential for barriers to access to impact the type of surgery a patient receives. We hypothesized that COVID may worsen these potential disparities. Charts were reviewed for children with single suture craniosynostosis from January 2014 to March 2020 (pre-COVID cohort) and March 2020 to September 2021 (COVID cohort) from 2 academic centers. 110 children were in the pre-COVID group; 56 were treated open and 54 endoscopically. Of the 44 patients in the COVID cohort, 20 were treated endoscopically and 24 were treated open. There was no significant difference in age of presentation or age of surgery across cohorts when considering type of surgery performed. Rate of endoscopy in the pre-COVID versus COVID cohorts was not significantly different. In both the pre-COVID and COVID cohorts there were significant differences between age of presentation, age of surgery, and type of surgery received based on race—black and Hispanic patients presented later, had surgery later, and underwent open surgery more frequently than their white/Asian counterparts ( P = .0095, P = .0067). The pandemic did not alter age of presentation/age of surgery or rates of patients receiving endoscopic surgery in patients with single suture craniosynostosis. There was no relationship between insurance status and type of surgery received during the pandemic, however Hispanic and black patients presented later and underwent surgery at an older age compared to white/Asian patients as they did pre-pandemic.

Pediatric Plastic Surgery in the COVID-19 Era

“…The authors attributed this to increased volume from coordinated community access efforts. 38 However, when stratified by race, both pre-COVID-19 and COVID-19 cohorts manifested statistically significant differences of older age at presentation and age at time of surgery for Black and Hispanic patients in comparison to White patients. When comparing the respective racial groups before and during COVID-19, there was no statistically significant difference in age at presentation, age at surgery, insurance type, or type of surgery performed.…”

“…37 A retrospective analysis of single suture craniosynostosis management before and after the pandemic examined the impact of health disparities. 38 Prompt repair of craniosynostosis, particularly in the first 6 months of life, is correlated with improved cognitive outcomes and is of great importance to the patient's development. 33,34 Of note, the pandemic did not result in an overall delay in care including consultations and surgery.…”

“…When comparing the respective racial groups before and during COVID-19, there was no statistically significant difference in age at presentation, age at surgery, insurance type, or type of surgery performed. 38 This is perhaps due to successful initiatives in closing gaps in disparities. On the other hand, it could mean that the pandemic created barriers to care, thus causing more families to switch from private insurance to Medicaid, or lost insurance due to unemployment or financial difficulties from economic decline as a result of the pandemic.…”

“…On the other hand, it could mean that the pandemic created barriers to care, thus causing more families to switch from private insurance to Medicaid, or lost insurance due to unemployment or financial difficulties from economic decline as a result of the pandemic. 38 An additional question became how to decrease exposure in the operating room during pediatric craniofacial procedures. The team of Abramowicz et al 39 credits 9 strategies in minimizing infection throughout the operative course in pediatric facial fractures during the pandemic.…”

“…It is well supported that disadvantaged and poor populations are disproportionately negatively impacted by pandemics as a result of overcrowding, poor housing, and poor nutrition 37 . A retrospective analysis of single suture craniosynostosis management before and after the pandemic examined the impact of health disparities 38 . Prompt repair of craniosynostosis, particularly in the first 6 months of life, is correlated with improved cognitive outcomes and is of great importance to the patient's development 33,34 .…”