American Association of Plastic Surgeons

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Comparing National Reoperation Rates: Cranial Vault Reconstruction versus Strip Craniectomy and Helmeting
Katelyn G. Bennett, MD MS, Niki Matusko, MS, Jennifer F. Waljee, MD MS, Christian J. Vercler, MD MA, Steven R. Buchman, MD.
University of Michigan, Ann Arbor, MI, USA.

Purpose: Cranial vault reconstruction (CVR) and strip craniectomy with helmeting (SC+H) both address craniosynostosis, but with notable differences in morbidity that seemingly favor SC+H. However, reoperation rates remain absent from the literature. We therefore sought to measure reoperation rates after CVR and SC+H using claims data. 
Methods: We examined insurance claims from OptumInsight between 2001 and 2017. A diagnosis of craniosynostosis and claims for cranioplasty were required for inclusion, and syndromic patients were excluded. Patients were identified as having undergone SC+H if they had helmet claims preoperatively or within 30 days after surgery. The primary outcome was risk of reoperation, which was defined as additional revision procedures more than 30 days after the index operation. Cox regression was used to measure the hazard ratio of reoperation by procedure type.
Results: In this cohort (n=2,002), 220 (11.0%) patients underwent SC+H, and 1,782 (89.4%) underwent CVR. Median follow up was 28.0 months (IQR: 10.6-63.8). Of this cohort, 165 (8.2%) patients underwent reoperation for craniosynostosis. After adjusting for relevant covariates, SC+H was associated with a significantly greater risk of reoperation (HR 1.35, p=0.018). SC+H was also associated with a significantly greater risk of salvage CVR (HR 1.61, p<0.001), but a significantly lower risk of fat or bone grafting (HR 0.14, p<0.012).
Conclusions: The risks of overall reoperation and salvage CVR were significantly higher for patients who underwent SC+H. Additionally, the revisions seen most commonly after CVR were much more minor in comparison. These findings highlight the questionable durability of SC+H compared with CVR.


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