Demographic and Complication Profiles of Patients Receiving Craniosynostosis Repair After 18 Months of Age

Abstract

Objective: Late surgical correction of craniosynostosis, defined as reconstruction after 18 months of age, poses various operative difficulties and outcome complications. Identification of patients at-risk for receiving late correction of craniosynostosis will assist in the management of these patients and may reduce overall morbidity associated with craniosynostosis surgery. The objective of this study is to identify patient populations at-risk of receiving late (> 18 months) surgical correction of craniosynostosis and the complications associated with late reconstruction. Methods: A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program pediatric database was performed from 2012 through 2019. Inclusion criteria involved patients who underwent correction of craniosynostosis determined by primary CPT codes 61550-9 between years 2012-2019. Additionally, primary CPT codes 21175, 21179, and 21180 were included if additional CPT codes 61550-9 were concurrently listed. Results: African American race, preterm birth prior to 30 weeks gestation, chronic lung disease, structural pulmonary abnormalities, prior cardiac surgery, seizure, and cerebral palsy were independently associated with increased odds of late surgical correction of craniosynostosis. Patients who received late cranial reconstruction experienced increased rates of surgical site infections (p = 0.0002), wound dehiscence (p = 0.0089), and perioperative bleeding requiring transfusion (p < 0.0001). Conclusion: Various comorbid factors increase the risk of receiving late correction of craniosynostosis. Given the increased complication profile of surgery after 18 months of age, close coordination and management of these patients is warranted. Additionally, when all comorbid factors are held statistically constant, African American patients receive craniosynostosis repair after 18 months of age 3 times more often than Caucasian patients. Future studies should focus on potential socioeconomic factors contributing to the racial disparity discovered in the timing of craniosynostosis repair. Corresponding author: Darin Patmon, 4254 Oak Forest Ct. SE Apt H8, Grand Rapids, MI 49546