Neighborhood Disadvantage Predicts Surgical Approach in Craniosynostosis Repair

Abstract

Objective

To assess whether patients with craniosynostosis differ in age at diagnosis, age at surgery, time from presentation to surgery, and receipt of minimally invasive versus open surgery according to their relative neighborhood-level socioeconomic disadvantage, as assessed by area deprivation index (ADI).

Design

Single-center retrospective cohort study.

Setting

Academic tertiary care center.

Patients

124 patients undergoing primary craniosynostosis repair from 2010 to 2023.

Main Outcome Measures

State area deprivation index quintile, age at diagnosis, age at surgery, time from presentation to surgery, operative approach of surgery (minimally invasive vs. open).

Results

Overall, 58.1% of patients were treated with minimally invasive surgery. A higher ADI quintile, indicating greater socioeconomic disadvantage, was associated with older age at diagnosis (Spearman's ρ=.264, P = .003), older age at primary surgery (Spearman's ρ=.291, P = .001), and increased time from presentation to surgery (Spearman's ρ=.179, P = .046). After adjusting for age at presentation, a higher ADI was also associated with an increased likelihood of undergoing open surgery (OR 1.516, 95% CI 1.032-2.225, P = .034).

Conclusions

In this group of patients undergoing primary craniosynostosis repair, those from more disadvantaged neighborhoods were more likely to be older at presentation and at surgery. They were also more likely to undergo open repair after adjusting for age at diagnosis, suggesting that extrinsic factors may differentially influence the selection of operative approach. Further outreach and advocacy efforts to improve equitable access to minimally invasive surgery are likely to help alleviate socioeconomic disparities in perioperative and long-term outcomes for patients with craniosynostosis.