Variation in the Utilization of Post-Operative Computed Tomography for Patients with Non-Syndromic Craniosynostosis: A National Claims Analysis
Katelyn G. Bennett, MD MS, Vidhya Gunaseelan, MS MHA, Christian J. Vercler, MD MA, Steven R. Buchman, MD, Jennifer F. Waljee, MD MS.
University of Michigan, Ann Arbor, MI, USA.
Purpose: The utilization of post-operative CT scans for routine follow up in non-syndromic craniosynostosis remains controversial due to the hazards of radiation exposure. The extent to which post-operative CTs are performed remains unknown. Therefore, we sought to ascertain the use of post-operative CTs in this patient population.
Methods: We obtained a cohort of craniosynostosis patients who underwent reconstruction between 2001 and 2017 using OptumInsight. Older age at surgery (>5 years), postoperative length of stay > 15 days, operative complications within 30 days of surgery, syndromic diagnoses, and cranial bone grafting merited exclusion. Our primary outcome was the use of post-operative CT scans. We used multilevel logistic regression to describe the odds of undergoing post-operative CTs, adjusting for patient and provider covariates.
Results: In this cohort (n=1,663), 448 patients (26.9%) underwent postoperative CTs, and the average number of post-operative CTs was 0.51 (range: 0-41). Intracranial hypertension (OR 1.82, p=0.044), older age at surgery (OR 1.35, p=0.001), increasing years of follow up (OR 1.12, p<0.001), and increasing comorbidities (OR 1.25, p=0.004) were associated with postoperative CTs. After adjusting for patient factors, provider factors still accounted for 30.5% of variation in imaging.
Conclusions: Almost 30% of patients underwent CTs following reconstruction, and provider factors accounted for a large percentage of the variation. Given the risks of radiation, the frequency of CTs for routine follow up is concerning. Neurosurgeons and craniofacial surgeons face a critical need to establish post-operative imaging protocols to reduce unnecessary imaging in this vulnerable patient population.
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