title: Differences in surgical outcomes for patients with craniosynostosis in the US: impact of socioeconomic variables and race.
abstract: OBJECT Craniosynostosis is often treated with neurosurgical intervention. The aim of this study was to report and analyze the clinical and socioeconomic characteristics of patients with craniosynostosis and to present current national trends. METHODS Using the Kids' Inpatient Database for the years 2000, 2003, 2006, and 2009, the authors identified patients with craniosynostosis using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes and their associated procedure codes. Clinical features, demographics, inpatient procedures, outcomes, and charges were collected and analyzed. RESULTS Of the 3415 patients identified, 65.8% were White, 21.4% were Hispanic, and 3.2% were Black. More than 96% were treated at urban teaching hospitals and 54.2% in southern or western regions. White patients were younger (mean 6.1 months) as compared with Blacks (mean 10.9 months) and Hispanics (mean 9.1 months; p < 0.0001) at the time of surgery. A higher fraction of Whites had private insurance (70.3%) compared with nonwhites (34.0%-41.6%; p < 0.001). Approximately 12.2% were nonelective admissions, more so among Blacks (16.9%). Mean hospital length of stay (LOS) was 3.5 days with no significant differences among races. Following surgical treatment, 12.1% of patients developed complications, most commonly pulmonary/respiratory (4.8%), wound infection (4.4%), and hydrocephalus (1.4%). The mean overall hospital charges were significantly lower for Whites than nonwhites ($34,527 vs $44,890-$48,543, respectively; p < 0.0001). CONCLUSIONS The findings of this national study suggest a higher prevalence of craniosynostosis in Hispanics. The higher predisposition among males was less evident in Hispanics and Blacks. There was a significant percentage of nonelective admissions, more commonly among Blacks. Additionally, Hispanics and Blacks were more likely to receive surgery at an older age, past the current recommendation of the optimum age for surgical intervention. These findings are likely associated with a lack of early detection. Although mean LOS and rate of complications did not significantly differ among different races, nonwhites had, on average, higher hospital charges of $10,000-$14,000. This discrepancy may be due to differences in type of insurance, craniosynostosis type, rates of comorbidities, and delay in treatment. Although there are several limitations to this analysis, the study reports on relevant disparities regarding a costly neurosurgical intervention, and ways to diminish these disparities should be further explored.
authors.affiliation: Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California; and.
authors.forename: Faris
authors.initials: F
authors.lastname: Shweikeh
authors.affiliation: Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California; and.
authors.forename: David
authors.initials: D
authors.lastname: Foulad
authors.affiliation: Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California; and.
authors.forename: Miriam
authors.initials: M
authors.lastname: Nuño
authors.affiliation: Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California; and.
authors.forename: Doniel
authors.initials: D
authors.lastname: Drazin
authors.affiliation: Department of Neurosurgery, Albany Medical Center, Albany, New York.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Adamo
mesh_terms: D044383:Black People / Q000208:ethnology*; D003398:Craniosynostoses / Q000191:economics / Q000208:ethnology / Q000601:surgery; D005260:Female; D006630:Hispanic or Latino / Q000208:ethnology*; D017722:Hospital Charges / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000191:economics / Q000208:ethnology; D012042:Registries / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014481:United States / Q000208:ethnology; D044465:White People / Q000208:ethnology*; D001741:Black or African American
keywords: ICD-9-CM = International Classification of Diseases, Ninth Revision, Clinical Modification; KID = Kids’ Inpatient Database; LOS = length of stay; complications; craniofacial; craniosynostosis; disparities; epidemiology; national analysis; outcomes