A National Longitudinal Socioeconomic Comparison of Strip Craniectomy Versus Whole Vault Cranioplasty in 2,052 Patients
Robin T. Wu, BS, Blake Shultz, BA, Kyle Gabrick, MD, Raysa Cabrejo, BS, Paul Abraham, BS, Michael Alperovich, MD, MSc.
Yale University School of Medicine, New Haven, CT, USA.
Nonsyndromic craniosynostosis can be treated with strip craniectomy or whole vault cranioplasty (WVC). Given dichotomous preferences, we conducted a large-scale database comparison of socioeconomic, cost, and complications between treatments.
Nonsyndromic craniosynostosis patients receiving strip craniectomies or WVC were identified in the Kids' Inpatient Database for years 2000, 2003, 2006, and 2009. Demographics, socioeconomics, charges, hospital characteristics, and outcomes were collected. Univariate and multivariate analyses were performed to compare variables between surgeries and across years.
A total of 251 strip craniectomy and 1,811 WVC patients were captured. More strip craniectomy patients were White and more WVC were Hispanic and Black (p<0.0001). More strip craniectomy patients had private insurance and more WVC patients had Medicaid (p<0.05). Over the years, WVC trended towards treating Hispanic and Medicaid patients. WVC charged hospitals $27,962 more than strip craniectomies, with $11,001 independent of payer, income, bedsize, and LOS (p<0.000). Strip craniectomies were performed more frequently in the West and Midwest, while WVC were done in the South (p=0.001). LOS was longer in WVC but not significantly. Outcomes were largely equivocal, with increased accidental puncture (p<0.05) and serum transfusion (p<0.01) in the WVC.
Our national longitudinal comparison shows widening socioeconomic disparities between strip craniectomies and WVC. WVC are increasingly being performed on racial minorities and Medicaid patients while strip craniectomies address a vastly White population with private insurance, without change. While hospital charges, LOS, and complications were increased among WVC, differences were smaller than expected and WVC continues to improve.
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