A 24-month cost and outcome analysis comparing traditional fronto-orbital advancment and remodeling with endoscopic strip craniectomy and molding helmet in the management of unicoronal craniosynostosis: A retrospective bi-institutional review

Jivraj, Bejaan; Ahmed, Naseer; Karia, Kunal; Menon, Ramshekhar; Robertson, Emilie M.; Sodha, Amee; Wormald, Justin C.R.; O’Hara, Justine; Jeelani, Owase; Dunaway, David; James, Greg; Ong, Juling

doi:10.1016/j.jpra.2019.01.010

Cited by 12 publications

(3 citation statements)

References 27 publications

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“…In our series, the average operative time for surgical correction was 205.8 minutes, and the periprocedural blood transfusion rate was 90.8% (69/76) with a mean transfusion volume of 176 mL, which is comparable to many series published from higher-income settings. [18][19][20] The rate of reoperations for infectious complications was higher in our study than in similar North American 21,22 and Chinese 23 studies. There is a paucity of literature regarding complication rates of craniosynostosis correction in LMICs; however, it is possible that this finding is a component of the learning curve in adopting a new surgical technique as well as an environmental risk factor of performing complex cranial procedures in the LMIC setting in which higher rates of surgical site infections are well established.…”

Section: International Mentorshipcontrasting

confidence: 52%

Nonsyndromic craniosynostosis in Vietnam: initial surgical outcomes of subspecialty mentorship

Can

Lepard

Anh

et al. 2021

Journal of Neurosurgery: Pediatrics

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OBJECTIVE There is a global deficit of pediatric neurosurgical care, and the epidemiology and overall surgical care for craniosynostosis is not well characterized at the global level. This study serves to highlight the details and early surgical results of a neurosurgical educational partnership and subsequent local scale-up in craniosynostosis correction. METHODS A prospective case series was performed with inclusion of all patients undergoing correction of craniosynostosis by extensive cranial vault remodeling at Children’s Hospital 2, Ho Chi Minh City, Vietnam, between January 1, 2015, and December 31, 2019. RESULTS A total of 76 patients were included in the study. The group was predominantly male, with a male-to-female ratio of 3.3:1. Sagittal synostosis was the most common diagnosis (50%, 38/76), followed by unilateral coronal (11.8%, 9/76), bicoronal (11.8%, 9/76), and metopic (7.9%, 6/76). The most common corrective technique was anterior cranial vault remodeling (30/76, 39.4%) followed by frontoorbital advancement (34.2%, 26/76). The overall mean operative time was 205.8 ± 38.6 minutes, and the estimated blood loss was 176 ± 89.4 mL. Eleven procedures were complicated by intraoperative durotomy (14.5%, 11/76) without any damage of dural venous sinuses or brain tissue. Postoperatively, 4 procedures were complicated by wound infection (5.3%, 4/76), all of which required operative wound debridement. There were no neurological complications or postoperative deaths. One patient required repeat reconstruction due to delayed intracranial hypertension. There was no loss to follow-up. All patients were followed at outpatient clinic, and the mean follow-up period was 32.3 ± 18.8 months postoperatively. CONCLUSIONS Surgical care for pediatric craniosynostosis can be taught and sustained in the setting of collegial educational partnerships with early capability for high surgical volume and safe outcomes. In the setting of the significant deficit in worldwide pediatric neurosurgical care, this study provides an example of the feasibility of such relationships in addressing this unmet need.

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Section: International Mentorshipcontrasting

confidence: 52%

Nonsyndromic craniosynostosis in Vietnam: initial surgical outcomes of subspecialty mentorship

Can

Lepard

Anh

et al. 2021

Journal of Neurosurgery: Pediatrics

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“…Jivraj et al recently reported a cost comparison for the treatment of unicoronal synostosis; because EAC is not practiced in the United Kingdom, the comparison was instead between data for open CVR (via FOA) performed at their center and data published by Jimenez and Barone for EAC performed in the United States, extrapolated to United Kingdomequivalent charges. 16,19 Though the study shows data consistent with our experience for decreased charges with endoscopic treatment, the data are difficult to apply to the United States healthcare billing model. Chan et al previously published a comparison of costs for a pooled cohort of patients with coronal, metopic, and sagittal synostosis, including syndromic and multisuture cases, 8 but the cost analysis was limited to the patients' hospital bills at dis-charge combined with helmeting costs for the endoscopic group.…”

Section: Discussionmentioning

confidence: 80%

“…11,16,24,28,32,35,40,42 With an increased focus on cost-effective healthcare delivery, previous studies have shown a significant decrease in financial burden with endoscopic treatment, most often demonstrated in patients with sagittal synostosis. 1,8,19,23,31,39 Fewer data are available on the charges associated with surgical treatment of nonsagittal synostosis (metopic, coronal, and lambdoid), for which traditional open remodeling procedures are distinct from those for sagittal synostosis. Lambdoid synostosis is the least common of these 4 synostosis types, and there is a corresponding paucity of studies including these rare patients.…”

Section: Discussionmentioning

confidence: 99%

Cost comparison of surgical management of nonsagittal synostosis: traditional open versus endoscope-assisted techniques

Zubovic

Lapidus

Skolnick

et al. 2020

Journal of Neurosurgery: Pediatrics

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OBJECTIVEManagement of craniosynostosis at an early age is important for mitigating the risk of abnormal cranial development, but treatment can result in significant expenses. Previous research has shown that endoscope-assisted craniectomy (EAC) is less costly than open cranial vault remodeling (CVR) for patients with sagittal synostosis. The aim of this study was to strengthen the existing body of healthcare cost research by elucidating the charges associated with open and endoscopic treatment for patients with nonsagittal synostosis.METHODSThe authors performed a retrospective analysis of data obtained in 41 patients who underwent open CVR and 38 who underwent EAC with postoperative helmet therapy for nonsagittal, single-suture craniosynostosis (metopic, coronal, and lambdoid) between 2008 and 2018. All patients were < 1 year of age at the time of surgery and had a minimum 1 year of follow-up. Inpatient charges, physician fees, helmet charges, and outpatient clinic visits in the 1st year were analyzed.RESULTSThe mean ages of the children treated with EAC and open CVR were 3.5 months and 8.7 months, respectively. Patients undergoing EAC with postoperative helmet therapy required more outpatient clinic visits in the 1st year than patients undergoing CVR (4 vs 2; p < 0.001). Overall, 13% of patients in the EAC group required 1 helmet, 30% required 2 helmets, 40% required 3 helmets, and 13% required 4 or more helmets; the mean total helmeting charges were $10,072. The total charges of treatment, including inpatient charges, physician fees, outpatient clinic visit costs, and helmet charges, were significantly lower for the EAC group than they were for the open CVR group ($50,840 vs $95,588; p < 0.001).CONCLUSIONSDespite the additional charges for postoperative helmet therapy and the more frequent outpatient visits, EAC is significantly less expensive than open CVR for patients with metopic, coronal, and lambdoid craniosynostosis. In conjunction with the existing literature on clinical outcomes and perioperative resource utilization, these data support EAC as a cost-minimizing treatment for eligible patients with nonsagittal synostosis.

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Long-term outcomes after surgical correction of anterior plagiocephaly secondary to isolated frontosphenoidal synostosis: a systematic review and two illustrative cases

Gutierrez-Pineda,

Pineda,

Özek

2024

Childs Nerv Syst

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A 24-month cost and outcome analysis comparing traditional fronto-orbital advancment and remodeling with endoscopic strip craniectomy and molding helmet in the management of unicoronal craniosynostosis: A retrospective bi-institutional review

Cited by 12 publications

References 27 publications

Nonsyndromic craniosynostosis in Vietnam: initial surgical outcomes of subspecialty mentorship

Nonsyndromic craniosynostosis in Vietnam: initial surgical outcomes of subspecialty mentorship

Cost comparison of surgical management of nonsagittal synostosis: traditional open versus endoscope-assisted techniques

Long-term outcomes after surgical correction of anterior plagiocephaly secondary to isolated frontosphenoidal synostosis: a systematic review and two illustrative cases

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