Complication Rates and Cost of Endoscopic and Open Surgical Approaches to Management of Craniosynostosis: A Large,National,Inpatient Cohort Evaluation

Abstract

Objective

To compare outcomes, complications, and costs between endoscopic and open surgical approaches in the management of craniosynostosis using a large national database.

Design

Retrospective cohort study.

Setting

National Inpatient Sample database, including inpatient hospital discharge data from 2018 to 2021 across 48 states and Washington, D.C.

Patients

The present study included 1099 patients admitted with a primary diagnosis of craniosynostosis. Among them, 183 (16.6%) underwent endoscopic surgery and 916 (83.3%) underwent open surgery.

Interventions

Surgical management of craniosynostosis, classified as either an endoscopic or open approach.

Main Outcome Measure(s)

Length of hospital stay, total procedure costs, and rates of inpatient complications, including surgical and medical complications.

Results

Endoscopic surgery was associated with a significantly shorter length of stay (mean 1.6 days vs 3.7 days, P < .001) and lower total costs ($ 66 815.90 vs $ 146 271.21, P < .001) compared to open procedures. It demonstrated lower rates of surgical complications (0.5% vs 7.9%, P < .001) and neurologic complications, primarily dural tears (0.5% vs 7.0%, P < .001). There were no differences in inpatient mortality between groups.

Conclusions

Endoscopic approaches to craniosynostosis offer advantages over open techniques, including reduced length of stay, costs, and complications. The present findings support the increasing adoption of endoscopic methods for craniosynostosis management. Future studies should assess the long-term impact on head shape durability and neurodevelopmental outcomes.