Impact of Social Vulnerability, Race, and Urbanicity on Surgical Timing for Patients With Craniosynostosis

Abstract

Prior studies have linked the timing of craniosynostosis surgeries to several postoperative outcomes. However, less is known regarding the influence of sociodemographic factors on surgical timing for this population. This study investigates the influence of social vulnerability index (SVI), race, and urbanicity on the timing of craniosynostosis surgery. Retrospective data from 2013 to 2023 were queried from Cosmos, a national deidentified database from Epic electronic health record. Patients were stratified into sociodemographic cohorts, and chi-square tests were used to compare the proportion of each cohort undergoing craniosynostosis surgeries before and after 6 months of age. More than 3000 patients were identified for each predetermined metric for sociodemographic analysis (SVI n = 3369, race n = 3541, urbanicity n = 3375). The proportion of patients undergoing surgery at 5 months or less decreased and those undergoing any surgery at 6 months or more increased ( P < .0001) with increasing SVI. There was also a significant association of surgical timing and patient race ( P < .0001) but not urbanicity. SVI and patient race are associated with the timing of craniosynostosis surgery. Specifically, higher social vulnerability and certain racial groups are correlated with delayed surgical intervention. This delay in presentation may result in the inability to take advantage of more minimally invasive options, such as strip craniectomy with or without cranial spring placement. These findings highlight the need for targeted, patient-specific, interventions to address disparities in access to timely craniosynostosis surgery.