Risk Factors for Delayed Referral to a Craniofacial Specialist for Treatment of Craniosynostosis

Gandolfi, Brad M.; Sobol, Danielle L.; Farjat, Alfredo E.; Allori, Alexander C.; Muh, Carrie R.; Marcus, Jeffrey R.

doi:10.1016/j.jpeds.2017.03.048

Cited by 30 publications

(38 citation statements)

References 16 publications

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“…By contrast, children in the control cohort largely represented the racially diverse community immediately surrounding the tertiary care center, which skews the comparative demographics. An emerging body of literature is exposing systemic delays in referral to specialty care based on demographics, including minority status and distance from a tertiary care hospital 37–39 . Discrepancies in access to prompt specialty care may account for some observed differences between cohorts and merit future study.…”

Section: Discussionmentioning

confidence: 99%

“…The prospective study design with a priori power analysis lends from a tertiary care hospital. [37][38][39] Discrepancies in access to prompt specialty care may account for some observed differences between cohorts and merit future study. Additional potential confounding factors known to be associated with LUTD, including socioeconomic status and psychological comorbidities, were not explicitly analyzed.…”

Section: Discussionmentioning

confidence: 99%

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A prospective survey study of lower urinary tract dysfunction in childhood cancer survivors after vincristine and/or doxorubicin chemotherapy

Hecht

Quach

Gao

et al. 2021

Pediatric Blood & Cancer

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Background Two chemotherapeutic agents used widely in pediatric oncology are vincristine (VCR) and doxorubicin (DOX), which may cause neuropathy and myopathy, respectively. The study hypothesis is that neurotoxic effects of VCR and/or myotoxic effects of DOX affect bladder physiology and manifest clinically as lower urinary tract dysfunction (LUTD). Procedure Based on a priori power analysis, 161 children divided evenly by gender were recruited. Children aged 5–10 years completed the dysfunctional voiding scoring system (DVSS) survey. The study cohort comprised cancer survivors treated with VCR and/or DOX. Healthy controls were recruited from well‐child clinic visits. Exclusion criteria included pelvic‐based malignancy, pelvic irradiation, pre‐existing LUTD, neurologic abnormalities, and treatment with cyclophosphamide/ifosfamide. DVSS scores and presence of LUTD, defined as DVSS scores above gender‐specific thresholds (males ≥9, females ≥6), were compared across cohorts. Results Median DVSS scores were higher in the study cohort (6 vs. 4, p = .003). Moreover, children in the study cohort were more likely to exceed threshold scores for LUTD (38.8% vs. 21%, p = .014; OR 1.8). Subanalysis by gender revealed female cancer survivors are more likely to report LUTD than controls (57.5% vs. 30%, p = .013, OR 1.9). This did not hold true for males (20% vs. 12.2%, p = .339). Conclusions Childhood cancer survivors who received VCR and/or DOX reported higher rates of LUTD than controls. Female cancer survivors appear more likely to suffer from LUTD than males. Further study with a positive control cohort of cancer survivors who received non‐VCR, non‐DOX chemotherapy is underway to elucidate the contribution of a cancer diagnosis to LUTD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A prospective survey study of lower urinary tract dysfunction in childhood cancer survivors after vincristine and/or doxorubicin chemotherapy

Hecht

Quach

Gao

et al. 2021

Pediatric Blood & Cancer

View full text Add to dashboard Cite

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“…There is increasing recognition that sociodemographic discrimination may exist within the healthcare system, and this may contribute to differences in outcomes and costs. 8,9 Racial minorities with craniosynostosis have been demonstrated to have delayed presentations, 10,11 such that some institutions rarely see minority patients present in the appropriate age window to be candidates for endoscopic repair. 12 More timely referral of marginalized patients may decrease cost burden on families and the health system.…”

Section: Discussionmentioning

confidence: 99%

Geographic Financial Analysis of Craniosynostosis Surgery in the United States

Kalmar

Zapatero

Kosyk

et al. 2022

Journal of Craniofacial Surgery

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Background: The purpose of this study was to investigate the financial implications of demographic and socioeconomic factors upon the cost of surgical procedures for craniosynostosis. Methods: A retrospective cohort study was conducted of admissions for craniosynostosis surgery in the United States from 2015 through 2020 using the Pediatric Health Information System. Patient demographics, case volume, and surgical approach were analyzed in context of hospital charges. Results: During the study interval, 3869 patients were admitted for surgery for craniosynostosis. In multivariate regression accounting for demographic and socioeconomic factors, hospital admission charges were significantly higher in patients with longer hospital length of stay (P < 0.001), longer ICU length of stay (P < 0.001), living in an underserved area (P = 0.046), preoperative risk factors (P = 0.016), and those undergoing open procedures (P < 0.001); hospital admission charges were significantly lower in patients with White race (P = 0.020) and those treated at high-volume centers (P < 0.001). In multivariate regression, ICU length of stay was significantly higher in patients with preoperative risk factors (P < 0.001), undergoing open procedures (P < 0.001), government insurance (P = 0.018), and not treated at high-volume centers (P = 0.005). There were significant differences in admission charges (P < 0.001), charge-to-cost ratios (P < 0.001), and likelihood of being treated at high-volume craniofacial centers (P < 0.001) across geographic regions of the country. Conclusions: In the United States, there is significant sociodemographic variability in charges for craniosynostosis care, with increased hospital charges independently associated with non-White race, preoperative risk factors, and living in an underserved area.

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“…In a single-center study, Chotai et al [21] also found that patients who identified as "other" race, defined as non-African American and non-Caucasian, had a higher likelihood of being unexpectedly readmitted within 90 days of undergoing a pediatric neurosurgical procedure (OR = 5.49; p = 0.024). Other examples where race has been found to have a statistically significant association include risk of seizures following traumatic brain injury [22], mortality with cerebral high-grade gliomas and spinal cord astrocytomas [23,24], access to neuro-oncologic care [25,26], delayed specialty referral for craniosynostosis [27,28], LOS following craniosynostosis surgery [29], and LOS, likelihood of inpatient death and nonroutine discharge following shunt surgery [30,31].…”

Section: Racementioning

confidence: 99%

Predictors of an Extended Length of Stay following an Elective Craniotomy in Children and Young Adults

et al. 2020

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Background: Length of stay (LOS) is now a generally accepted clinical metric within the USA. An extended LOS following an elective craniotomy can significantly impact overall costs. Few studies have evaluated predictors of an extended LOS in pediatric neurosurgical patients. Objective: The aim of the study was to determine predictors of an extended hospital LOS following an elective craniotomy in children and young adults. Methods: All pediatric patients and young adults undergoing an elective craniotomy between January 1, 2010, and April 1, 2019, were retrospectively identified using a prospectively maintained database. Demographic, clinical, radiological, and surgical data were collected. The primary outcome was extended LOS, defined as a postsurgical stay greater than 7 days. Bivariate and multivariable analyses were performed. Results: A total of 1,498 patients underwent 1,720 elective craniotomies during the study period over the course of 1,698 hospitalizations with a median LOS of 4 days (interquartile range 3–6 days). Of these encounters, 218 (12.8%) had a prolonged LOS. Multivariable analysis demonstrated that non-Caucasian race (OR = 1.9 [African American]; OR = 1.6 [other]), the presence of an existing shunt (OR = 1.8), the type of craniotomy (OR = 0.3 [vascular relative to Chiari]), and the presence of a postoperative complication (OR = 14.7) were associated with an extended LOS. Conclusions: Inherent and modifiable factors predict a hospital stay of more than a week in children and young adults undergoing an elective craniotomy.

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Risk Factors for Delayed Referral to a Craniofacial Specialist for Treatment of Craniosynostosis

Cited by 30 publications

References 16 publications

A prospective survey study of lower urinary tract dysfunction in childhood cancer survivors after vincristine and/or doxorubicin chemotherapy

A prospective survey study of lower urinary tract dysfunction in childhood cancer survivors after vincristine and/or doxorubicin chemotherapy

Geographic Financial Analysis of Craniosynostosis Surgery in the United States

Predictors of an Extended Length of Stay following an Elective Craniotomy in Children and Young Adults

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