title: A comparison of costs associated with endoscope-assisted craniectomy versus open cranial vault repair for infants with sagittal synostosis.
abstract: OBJECTIVE
  The surgical management of infants with sagittal synostosis has traditionally relied on open cranial vault remodeling (CVR) techniques; however, minimally invasive technologies, including endoscope-assisted craniectomy (EAC) repair followed by helmet therapy (HT, EAC+HT), is increasingly used to treat various forms of craniosynostosis during the 1st year of life. In this study the authors determined the costs associated with EAC+HT in comparison with those for CVR.
  
  
  METHODS
  The authors performed a retrospective case-control analysis of 21 children who had undergone CVR and 21 who had undergone EAC+HT. Eligibility criteria included an age less than 1 year and at least 1 year of clinical follow-up data. Financial and clinical records were reviewed for data related to length of hospital stay and transfusion rates as well as costs associated with physician, hospital, and outpatient clinic visits.
  
  
  RESULTS
  The average age of patients who underwent CVR was 6.8 months compared with 3.1 months for those who underwent EAC+HT. Patients who underwent EAC+HT most often required the use of 2 helmets (76.5%), infrequently required a third helmet (13.3%), and averaged 1.8 clinic visits in the first 90 days after surgery. Endoscope-assisted craniectomy plus HT was associated with shorter hospital stays (mean 1.10 vs 4.67 days for CVR, p < 0.0001), a decreased rate of blood transfusions (9.5% vs 100% for CVR, p < 0.0001), and a decreased operative time (81.1 vs 165.8 minutes for CVR, p < 0.0001). The overall cost of EAC+HT, accounting for hospital charges, professional and helmet fees, and clinic visits, was also lower than that of CVR ($37,255.99 vs $56,990.46, respectively, p < 0.0001).
  
  
  CONCLUSIONS
  Endoscope-assisted craniectomy plus HT is a less costly surgical option for patients than CVR. In addition, EAC+HT was associated with a lower utilization of perioperative resources. Theses findings suggest that EAC+HT for infants with sagittal synostosis may be a cost-effective first-line surgical option.
authors.affiliation: Department of Neurosurgery and.
authors.forename: Timothy W
authors.initials: TW
authors.lastname: Vogel
authors.forename: Albert S
authors.initials: AS
authors.lastname: Woo
authors.forename: Alex A
authors.initials: AA
authors.lastname: Kane
authors.forename: Kamlesh B
authors.initials: KB
authors.lastname: Patel
authors.forename: Sybill D
authors.initials: SD
authors.lastname: Naidoo
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Smyth
mesh_terms: D001803:Blood Transfusion / Q000191:economics; D016022:Case-Control Studies; D002648:Child; D003362:Cost-Benefit Analysis; D003398:Craniosynostoses / Q000191:economics* / Q000601:surgery*; D003399:Craniotomy / Q000191:economics* / Q000379:methods*; D004180:Direct Service Costs; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000191:economics; D008297:Male; D044583:Neuroendoscopy / Q000191:economics*; D061646:Operative Time; D012189:Retrospective Studies; D018401:Sample Size; D015983:Selection Bias; D012886:Skull / Q000601:surgery*; D016896:Treatment Outcome