Surgical Timing And Neurocognitive Development Among Patients With Craniosynostosis: Analysis Of Confounding Variables And Selection Bias
Jeremy V. Lynn, BS, Lauren K. Buchman, N/A, Christopher J. Breuler, MD, Steven R. Buchman, MD.
University of Michigan, Ann Arbor, MI, USA.
Purpose: In 1988, Renier et al postulated that delayed cranial vault remodeling causes slowed neurocognitive development among patients with craniosynostosis. The purpose of this study is to identify factors potentially confounding this cause-and-effect relationship. We hypothesize that children with socioeconomic disadvantages or comorbid diagnoses are more likely to undergo delayed cranial vault remodeling and may represent a selection bias toward slowed neurocognitive development.
Methods: A retrospective review study was designed. All patients with non-syndromic single-suture craniosynostosis who underwent cranial vault remodeling between 2009 and 2020 at the University of Michigan were included (n=227). Demographic, socioeconomic, and clinical variables were documented. The sample was dichotomized to compare patients who underwent cranial vault remodeling before (Early) and after (Late) 12 months of age. Chi-square analysis was performed at p<0.05 significance.
Results: The Early and Late groups contained 157 patients and 70 patients, respectively. Compared to the Early group, the Late group contained a significantly larger proportion of patients who identified as non-white (p=0.03), qualified for need-based financial assistance (p=0.03), were born preterm (p<0.01), or carried a comorbid diagnosis (p<0.01). Based on pre-operative testing, the Late group contained a significantly larger proportion of patients with baseline cognitive delays relative to the Early group (p=0.011).
Conclusion: This study demonstrates that socioeconomic disadvantages and comorbid diagnoses are associated with delayed cranial vault remodeling and may represent a selection bias toward slowed neurocognitive development. Future studies evaluating the relationship between surgical timing and neurocognitive development must consider confounders and selection biases.
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