Open Repair Versus Closed Repair: A Cost-Analysis of the Two Surgical Approaches for the Treatment of Craniosynostoses

Stanbouly, Dani; Ascherman, Jeffrey A.; Chuang, Sung-Kiang

doi:10.1016/j.joms.2021.08.165

Cited by 6 publications

(18 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In contrast, patients from lower-income quartiles received more open procedures. 15,18,22 SES was not associated with treatment type in 2 national database reviews. 20,24 All 6 studies that investigated the impacts of hospital size or volume were retrospective national database reviews.…”

Section: Treatment Received and Treatment Center Volumementioning

confidence: 90%

“…Access to craniosynostosis evaluation and surgical care varied based on patient race, insurance status, and socioeconomic status (Table 1). Seventeen of the 28 studies analyzed differences in time to craniosynostosis diagnosis, referral, or surgical intervention (7 single-institution cohort reviews, 10 national database reviews, and 2 dual-institution cohort revi ews) 3,4,[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] . Ten 3,4,[7][8][9]11,13,15,17,19 of the 17 studies investigated racial disparities in access to care, all of which found that non-white patients were more likely to experience a delay to at least one step of the diagnostic process (i.e., diagnosis, referral, or intervention) compared to White patients.…”

Section: Time To Diagnosis Referral and Interventionmentioning

confidence: 99%

“…3,15 Six studies investigated the consequences of presenting for surgery at an older age. 6,10,14,16,18,20 Of these, one national database review found that older age at the time of surgical intervention was associated with increased surgical complication rate and increased hospital length of stay. 10 Five studies (3 national database reviews and 2 single-institution cohort reviews) found that older patients were more likely to undergo open surgical approaches than those who presented at younger ages.…”

Section: Time To Diagnosis Referral and Interventionmentioning

confidence: 99%

See 2 more Smart Citations

Scoping Review of Healthcare Disparities in Treatment of Craniosynostosis: Assessing Impacts of Race, Insurance, and Socioeconomic Status

Amin,

Tursak,

Ulma

et al. 2024

FACE

View full text Add to dashboard Cite

Background: Racial and socioeconomic factors persist as barriers to timely diagnosis and treatment for children with craniosynostosis, contributing to inequitable care. This scoping review aims to better understand how disparities influence differences in services, approach, and outcomes for patients undergoing surgical corrections for craniosynostosis. Methods: We conducted a PRISMA systematic review of all articles published between 2003 and 2023 within PubMed/Medline, Embase, and a Scopus cited review. Variables of interest included sociodemographic factors such as race, socioeconomic status (SES), and insurance status, and measurements of treatment access or outcomes within craniosynostosis surgical repair. Results: The final analysis included 28 studies, of which 21 studies examined race, 13 examined insurance status, and 5 examined household income or other socioeconomic factors. Overall, non-White, minority patients, patients with Medicaid or government-funded insurance, and patients from lower SES were more likely to experience delays in diagnosis and presentation for surgery compared to White and privately-insured patients. Black and Hispanic patients and patients with public insurance were more likely to undergo open cranial vault reconstruction (CVR) at an older age and experience longer total surgery time, increasing perioperative complication risk, compared to patients who underwent endoscopic procedures. Sociodemographic factors including non-White race, lower SES, and being underinsured or uninsured predisposed patients to the more expensive CVR procedure, increased hospital length of stay (LOS), and a higher rate of readmission, accumulating to greater total cost of care. Conclusion: Significant disparities continue to exist in craniosynostosis management. It is still unknown whether these discrepancies in the type of operation lead to significant clinical differences in neurocognitive outcomes, revision operations, or patient/parent satisfaction with appearance. This study highlights gaps in the current body of knowledge to better inform future aeas of investigation to ensure the best outcomes for all children born with craniosynostosis regardless of patient demographic.

show abstract

Section: Treatment Received and Treatment Center Volumementioning

confidence: 90%

Section: Time To Diagnosis Referral and Interventionmentioning

confidence: 99%

Section: Time To Diagnosis Referral and Interventionmentioning

confidence: 99%

See 1 more Smart Citation

Scoping Review of Healthcare Disparities in Treatment of Craniosynostosis: Assessing Impacts of Race, Insurance, and Socioeconomic Status

Amin,

Tursak,

Ulma

et al. 2024

FACE

View full text Add to dashboard Cite

show abstract

“…During the postoperative helmet therapy course, 1 to 2 helmets were used depending on serial measurements and the patient’s clinical course. It may be burdensome for the patient’s family to pay the cost of postoperative helmet therapy if it is not covered by insurance 10–12 . In addition, helmets should be worn 23 hours a day until the age of 1 year, 6,7,11 which might be stressful for patients.…”

Section: Discussionmentioning

confidence: 99%

“…It may be burdensome for the patient's family to pay the cost of postoperative helmet therapy if it is not covered by insurance. [10][11][12] In addition, helmets should be worn 23 hours a day until the age of 1 year, 6,7,11 which might be stressful for patients. We should consider not only minimally invasive surgery in terms of surgical invasiveness but also in terms of these additional factors.…”

Section: Discussionmentioning

confidence: 99%

Is Postoperative Helmet Molding Therapy Necessary for Craniectomy for Sagittal Suture Synostosis?

Uno,

Sakamoto,

Miwa

2023

Journal of Craniofacial Surgery

View full text Add to dashboard Cite

Endoscopic strip craniectomy followed by postoperative remodeling helmet therapy for scaphocephaly is widely accepted, but the requirement of several helmets might burden patients or their families. This study examined whether craniectomy via a bicoronal approach without molding helmet therapy is worth considering. The authors retrospectively reviewed patients with nonsyndromic sagittal suture synostosis who underwent the modified Renier H technique between 2016 and 2021. We collected data on preoperative and postoperative cephalic index (CI), operative time, estimated blood loss, and blood transfusion rates. The authors also examined all related literature in English describing endoscopic craniectomy with postoperative helmet molding therapy for sagittal suture craniosynostosis. Among 17 patients, the average operative time was 92.2±15.6 minutes, the mean estimated blood loss was 35.8±22.4 mL, and a blood transfusion was needed for 9 patients (52.9%). The mean preoperative and postoperative CIs were 69.1±2.6 and 78.4±2.2, respectively. A comparison of the literature review with the authors’ results showed that their procedures required a slightly longer operative time and a higher frequency of blood transfusions. There are no significant differences in blood loss or preoperative and postoperative CIs reported in the literature. The open procedure required a higher operative time than endoscopic suturectomy. However, dealing with bleeding is more challenging with endoscopic suturectomy. The cost of the helmets and the duration patients have to wear them, which might be burdensome for the patients or their families when determining the optimal minimally invasive treatment, should also be considered.

show abstract

Nonsyndromic Craniosynostosis Correlation Between Ethnicity, Race, and Pattern of Affected Suture Type: Meta-Analysis

Benaroch,

Brozynski,

Seyidova

et al. 2024

Journal of Craniofacial Surgery

View full text Add to dashboard Cite

Background: Previous studies have sought to analyze risk factors associated with craniosynostosis and while syndromic craniosynostosis is often linked to genetic mutations, the factors impacting nonsyndromic cases are less investigated. The aim of current meta-analysis is to evaluate the relationship between ethnicity and suture type in nonsyndromic craniosynostosis patients. Methods: The search term “craniosynostosis [Title/Abstract] AND (race [Title/Abstract] OR ethnicity [Title/Abstract])) NOT (syndrome [Title/Abstract])” was used to search the PubMed, Cochrane, and MEDLINE databases. Analyses were conducted separately for each racial and ethnic group for each suture type cohort. Odds ratios were conducted for each suture cohort and confounders were adjusted using linear mixed-effect models. Because of the homogeneity of the populations and categorical nature of the classification, binary logistic regression was run on aggregate data. Results: The literature search yielded 165 articles. After reviewing titles, abstracts, and manuscript contents of these articles, 5 studies were ultimately included in a meta-analysis. Studies with missing data for a particular cohort or variable were excluded from the respective analysis. Hispanic children had higher odds of sagittal suture involvement (OR: 1.53, P<0.001), whereas Asian had coronal suture (OR: 2.47, P<0.001). Both Asian and African American children had significantly lower odds of sagittal suture involvement (OR: 0.50, P<0.001 and OR: 0.7, P=0.04, respectively). Conclusion The relationship between ethnicity and craniosynostosis has been suggested as a risk factor, but without definitive conclusion. Present meta-analysis findings demonstrated association between ethnicity and suture type, however further research with larger scale and geographically varied data is warranted.

show abstract

Open Repair Versus Closed Repair: A Cost-Analysis of the Two Surgical Approaches for the Treatment of Craniosynostoses

Cited by 6 publications

References 17 publications

Scoping Review of Healthcare Disparities in Treatment of Craniosynostosis: Assessing Impacts of Race, Insurance, and Socioeconomic Status

Scoping Review of Healthcare Disparities in Treatment of Craniosynostosis: Assessing Impacts of Race, Insurance, and Socioeconomic Status

Is Postoperative Helmet Molding Therapy Necessary for Craniectomy for Sagittal Suture Synostosis?

Nonsyndromic Craniosynostosis Correlation Between Ethnicity, Race, and Pattern of Affected Suture Type: Meta-Analysis

Contact Info

Product

Resources

About