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

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Management 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.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>The 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 &lt; 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.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>The 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 &lt; 0.001<jats:italic>).</jats:italic> 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 &lt; 0.001).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Despite 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.</jats:p></jats:sec>

Endoscopic Versus Open Cranial Reconstruction Surgery for Anterior Craniosynostosis: Experience from South-East Asia

“…Most of the sutures involved were the anterior sutures (metopic and coronal). The mean age at surgery in the endoscopic group was 3.7 months (3-5) and higher at 11.5 months (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) in the open group (P < .05). The duration of surgery, blood loss and overall length of hospital stay were significantly reduced in the endoscopic group (P < .05).…”

“…In unicoronal patients, the nasal root deviation improves with time. 16,14 However, the supraorbital hollowness is slow to correct and in our series, we had 2 patients with unicoronal synostosis who had a sub-optimal supra orbital correction which is slow to correct (Figures 3, 5, 6, and 11) This may partly be due to poor parental compliance, and to reduced number of helmets (one patient) due to financial constraints. Based on our data, it is unclear at what time point patients with unicoronal synostosis obtain complete frontal correction.…”

“…5,7,9,15,16,17,14 Most studies agree that 3 months is the ideal time to perform this surgery, 9,15 as the bone is soft, and the skull is amenable to molding. Almost all the studies have unanimously agreed that blood loss, surgical duration, length of hospitalization and cost 10,16,17,12,14 are significantly reduced, and our current study has clearly highlighted this difference. This study has demonstrated a clear difference in aesthetic outcomes of metopic and coronal patients treated with the endoscopic option, at the time of completion of helmet therapy.…”

Pediatric Fronto-Orbital Skull Reconstruction

“…17 In addi-tion, strip craniectomy has been found to be more cost-effective than FOA for the treatment of nonsagittal, single-suture craniosynostosis. 20 In contrast to FOA, fronto-orbital distraction allows for advancement of the anterior cranial vault without disrupting the bone-dura interface. 21 The maintenance of this interface results in decreased intraoperative blood loss and improved osteogenesis.…”

Minimally invasive strip craniectomy for metopic craniosynostosis using a lighted retractor

“…The video can be found here: https://vimeo.com/511237503 https://thejns.org/doi/abs/10.3171/2021.1.FOCVID20123 KEYWORDS craniosynostosis; endoscope; metopic; minimally invasive; retractor minimally invasive approach has been demonstrated to be more cost-effective than open remodeling. 8 In our practice, it is offered to all patients younger than 6 months of age, but the ideal patient is younger than 4 months, so that postoperative orthotic therapy can be initiated during the period of maximum brain growth.…”