Differences in surgical outcomes for patients with craniosynostosis in the US: impact of socioeconomic variables and race

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>Craniosynostosis is often treated with neurosurgical intervention. The aim of this study was to report and analyze the clinical and socioeconomic characteristics of patients with craniosynostosis and to present current national trends.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>Using the Kids’ Inpatient Database for the years 2000, 2003, 2006, and 2009, the authors identified patients with craniosynostosis using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes and their associated procedure codes. Clinical features, demographics, inpatient procedures, outcomes, and charges were collected and analyzed.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Of the 3415 patients identified, 65.8% were White, 21.4% were Hispanic, and 3.2% were Black. More than 96% were treated at urban teaching hospitals and 54.2% in southern or western regions. White patients were younger (mean 6.1 months) as compared with Blacks (mean 10.9 months) and Hispanics (mean 9.1 months; p &lt; 0.0001) at the time of surgery. A higher fraction of Whites had private insurance (70.3%) compared with nonwhites (34.0%–41.6%; p &lt; 0.001). Approximately 12.2% were nonelective admissions, more so among Blacks (16.9%). Mean hospital length of stay (LOS) was 3.5 days with no significant differences among races. Following surgical treatment, 12.1% of patients developed complications, most commonly pulmonary/respiratory (4.8%), wound infection (4.4%), and hydrocephalus (1.4%). The mean overall hospital charges were significantly lower for Whites than nonwhites ($34,527 vs $44,890–$48,543, respectively; p &lt; 0.0001).</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>The findings of this national study suggest a higher prevalence of craniosynostosis in Hispanics. The higher predisposition among males was less evident in Hispanics and Blacks. There was a significant percentage of nonelective admissions, more commonly among Blacks. Additionally, Hispanics and Blacks were more likely to receive surgery at an older age, past the current recommendation of the optimum age for surgical intervention. These findings are likely associated with a lack of early detection. Although mean LOS and rate of complications did not significantly differ among different races, nonwhites had, on average, higher hospital charges of $10,000–$14,000. This discrepancy may be due to differences in type of insurance, craniosynostosis type, rates of comorbidities, and delay in treatment. Although there are several limitations to this analysis, the study reports on relevant disparities regarding a costly neurosurgical intervention, and ways to diminish these disparities should be further explored.</jats:p></jats:sec>

Racial disparities in health care access among pediatric patients with craniosynostosis

“…19 Faris et al evaluated the impact of race on surgical outcomes of 3415 children surgically treated for craniosynostosis between 2000 and 2009 identified using the national Kids' Inpatient Database. 28 Similarly, they report that Caucasian patients were significantly younger at the time of surgery as compared with African American or Hispanic patients (6.1, 10.9, and 9.1 months, respectively; p < 0.0001).…”

Skin Deep: Perception of Scars After Cranial Vault Reconstruction

“…Nonwhite race approached, but did not meet, a statistically significant association with increased patient scar selfconsciousness scores, which could suggest that the presence of a craniofacial deformity is likely a more foundational determinant of patient self-consciousness regardless of ethnic background. There are data that suggest that nonwhite patients are more likely to present in a delayed fashion for surgical care in comparison to their white counterparts (Shweikeh et al, 2016), but this effect was not reflected in our cohort. It is difficult to know to what extent aesthetic evaluations of scars are influenced by hair texture and length.…”

Massive Lumbosacral Subcutaneous Exudate After Surgical Treatment of a Large Lipomyelocele

“…11 Therefore, it is now commonly believed that surgery should be performed as soon as possible, before the occurrence or exacerbation of clinical symptoms. 12 – 14 In addition, it has been demonstrated that surgery performed on symptom-free patients can prevent the development of late neurological deficits. 3 , 14 …”

“…12 – 14 In addition, it has been demonstrated that surgery performed on symptom-free patients can prevent the development of late neurological deficits. 3 , 14 …”