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Endoscopic Versus Open Surgery For Craniosynostosis: Equal Access, Unequal Outcomes
Danielle H. Rochlin, MD, Clifford C. Sheckter, MD, H. Peter Lorenz, MD, Rohit Khosla, MD.
Stanford University, Palo Alto, CA, USA.

PURPOSE: Optimal surgical treatment for craniosynostosis remains controversial. The purpose of this study is to evaluate national differences in inpatient outcomes and predictors of treatment type for endoscopic versus open surgery for craniosynostosis.
METHODS: The 2016 Kidsí Inpatient Database was queried to identify patients aged 3 years or younger who underwent craniectomy for craniosynostosis. Multivariable regression modeled treatment type based on patient-level (gender, race, income, comorbidities, payer) and facility-level (bed size, region, teaching status) variables, and was used to assess outcomes.
RESULTS: The weighted sample included 514 patients, of whom 81.5% were under age 1 year and 13.8% were syndromic. 83.0% of procedures were open and 17.0% were endoscopic. Patients were more likely to be treated open if they were older (odds ratio [OR] 3.2, p=0.007) or syndromic (OR 9.7, p=0.026). Racial, socioeconomic, and geographic factors were not significantly associated with treatment type. Open repair was associated with more transfusions (23.4% vs. 9.5%, p=0.030), longer inpatient stay (mean 3.0 vs. 1.7 days, p<0.001), and more costly hospitalizations (mean $25,674.8 vs. $14,734.0, p=0.019). Complications did not significantly vary between procedure type, though syndromic patients were more likely to have systemic (OR 4.2, p=0.003) and local (OR 3.7, p=0.016) complications.
CONCLUSION: US national data demonstrate that age and syndromic comorbidities predict method of repair. There were no significant racial, socioeconomic, or geographic disparities in predictors of treatment type. Compared to open, endoscopic surgery showed benefits including lower transfusion risk, shorter hospital stay, and lower costs, without a significant change in postoperative complications.


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