Differences in surgical outcomes for patients with craniosynostosis in the US: Impact of socioeconomic variables and race

Faris Shweikeh, David Foulad, Miriam A Nuno, Doniel Drazin, Matthew A. Adamo

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objective Craniosynostosis is often treated with neurosurgical intervention. The aim of this study was to report and analyze the clinical and socioeconomic characteristics of patients with craniosynostosis and to present current national trends. methods Using the Kids' Inpatient Database for the years 2000, 2003, 2006, and 2009, the authors identified patients with craniosynostosis using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes and their associated procedure codes. Clinical features, demographics, inpatient procedures, outcomes, and charges were collected and analyzed. results Of the 3415 patients identified, 65.8% were White, 21.4% were Hispanic, and 3.2% were Black. More than 96% were treated at urban teaching hospitals and 54.2% in southern or western regions. White patients were younger (mean 6.1 months) as compared with Blacks (mean 10.9 months) and Hispanics (mean 9.1 months; p < 0.0001) at the time of surgery. A higher fraction of Whites had private insurance (70.3%) compared with nonwhites (34.0%-41.6%; p < 0.001). Approximately 12.2% were nonelective admissions, more so among Blacks (16.9%). Mean hospital length of stay (LOS) was 3.5 days with no significant differences among races. Following surgical treatment, 12.1% of patients developed complications, most commonly pulmonary/respiratory (4.8%), wound infection (4.4%), and hydrocephalus (1.4%). The mean overall hospital charges were significantly lower for Whites than nonwhites ($34,527 vs $44,890-$48,543, respectively; p < 0.0001). conclusions The findings of this national study suggest a higher prevalence of craniosynostosis in Hispanics. The higher predisposition among males was less evident in Hispanics and Blacks. There was a significant percentage of nonelective admissions, more commonly among Blacks. Additionally, Hispanics and Blacks were more likely to receive surgery at an older age, past the current recommendation of the optimum age for surgical intervention. These findings are likely associated with a lack of early detection. Although mean LOS and rate of complications did not significantly differ among different races, nonwhites had, on average, higher hospital charges of $10,000-$14,000. This discrepancy may be due to differences in type of insurance, craniosynostosis type, rates of comorbidities, and delay in treatment. Although there are several limitations to this analysis, the study reports on relevant disparities regarding a costly neurosurgical intervention, and ways to diminish these disparities should be further explored.

Original languageEnglish (US)
Pages (from-to)27-33
Number of pages7
JournalJournal of Neurosurgery: Pediatrics
Volume17
Issue number1
DOIs
StatePublished - Jan 1 2016
Externally publishedYes

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Craniosynostoses
Hispanic Americans
Hospital Charges
Length of Stay
Insurance
Inpatients
Urban Hospitals
International Classification of Diseases
Wound Infection
Hydrocephalus
Teaching Hospitals
Comorbidity
Demography
Databases
Lung
Therapeutics

Keywords

  • Complications
  • Craniofacial
  • Craniosynostosis
  • Disparities
  • Epidemiology
  • National analysis
  • Outcomes

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Differences in surgical outcomes for patients with craniosynostosis in the US : Impact of socioeconomic variables and race. / Shweikeh, Faris; Foulad, David; Nuno, Miriam A; Drazin, Doniel; Adamo, Matthew A.

In: Journal of Neurosurgery: Pediatrics, Vol. 17, No. 1, 01.01.2016, p. 27-33.

Research output: Contribution to journalArticle

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abstract = "Objective Craniosynostosis is often treated with neurosurgical intervention. The aim of this study was to report and analyze the clinical and socioeconomic characteristics of patients with craniosynostosis and to present current national trends. methods Using the Kids' Inpatient Database for the years 2000, 2003, 2006, and 2009, the authors identified patients with craniosynostosis using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes and their associated procedure codes. Clinical features, demographics, inpatient procedures, outcomes, and charges were collected and analyzed. results Of the 3415 patients identified, 65.8{\%} were White, 21.4{\%} were Hispanic, and 3.2{\%} were Black. More than 96{\%} were treated at urban teaching hospitals and 54.2{\%} in southern or western regions. White patients were younger (mean 6.1 months) as compared with Blacks (mean 10.9 months) and Hispanics (mean 9.1 months; p < 0.0001) at the time of surgery. A higher fraction of Whites had private insurance (70.3{\%}) compared with nonwhites (34.0{\%}-41.6{\%}; p < 0.001). Approximately 12.2{\%} were nonelective admissions, more so among Blacks (16.9{\%}). Mean hospital length of stay (LOS) was 3.5 days with no significant differences among races. Following surgical treatment, 12.1{\%} of patients developed complications, most commonly pulmonary/respiratory (4.8{\%}), wound infection (4.4{\%}), and hydrocephalus (1.4{\%}). The mean overall hospital charges were significantly lower for Whites than nonwhites ($34,527 vs $44,890-$48,543, respectively; p < 0.0001). conclusions The findings of this national study suggest a higher prevalence of craniosynostosis in Hispanics. The higher predisposition among males was less evident in Hispanics and Blacks. There was a significant percentage of nonelective admissions, more commonly among Blacks. Additionally, Hispanics and Blacks were more likely to receive surgery at an older age, past the current recommendation of the optimum age for surgical intervention. These findings are likely associated with a lack of early detection. Although mean LOS and rate of complications did not significantly differ among different races, nonwhites had, on average, higher hospital charges of $10,000-$14,000. This discrepancy may be due to differences in type of insurance, craniosynostosis type, rates of comorbidities, and delay in treatment. Although there are several limitations to this analysis, the study reports on relevant disparities regarding a costly neurosurgical intervention, and ways to diminish these disparities should be further explored.",
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AU - Drazin, Doniel

AU - Adamo, Matthew A.

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N2 - Objective Craniosynostosis is often treated with neurosurgical intervention. The aim of this study was to report and analyze the clinical and socioeconomic characteristics of patients with craniosynostosis and to present current national trends. methods Using the Kids' Inpatient Database for the years 2000, 2003, 2006, and 2009, the authors identified patients with craniosynostosis using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes and their associated procedure codes. Clinical features, demographics, inpatient procedures, outcomes, and charges were collected and analyzed. results Of the 3415 patients identified, 65.8% were White, 21.4% were Hispanic, and 3.2% were Black. More than 96% were treated at urban teaching hospitals and 54.2% in southern or western regions. White patients were younger (mean 6.1 months) as compared with Blacks (mean 10.9 months) and Hispanics (mean 9.1 months; p < 0.0001) at the time of surgery. A higher fraction of Whites had private insurance (70.3%) compared with nonwhites (34.0%-41.6%; p < 0.001). Approximately 12.2% were nonelective admissions, more so among Blacks (16.9%). Mean hospital length of stay (LOS) was 3.5 days with no significant differences among races. Following surgical treatment, 12.1% of patients developed complications, most commonly pulmonary/respiratory (4.8%), wound infection (4.4%), and hydrocephalus (1.4%). The mean overall hospital charges were significantly lower for Whites than nonwhites ($34,527 vs $44,890-$48,543, respectively; p < 0.0001). conclusions The findings of this national study suggest a higher prevalence of craniosynostosis in Hispanics. The higher predisposition among males was less evident in Hispanics and Blacks. There was a significant percentage of nonelective admissions, more commonly among Blacks. Additionally, Hispanics and Blacks were more likely to receive surgery at an older age, past the current recommendation of the optimum age for surgical intervention. These findings are likely associated with a lack of early detection. Although mean LOS and rate of complications did not significantly differ among different races, nonwhites had, on average, higher hospital charges of $10,000-$14,000. This discrepancy may be due to differences in type of insurance, craniosynostosis type, rates of comorbidities, and delay in treatment. Although there are several limitations to this analysis, the study reports on relevant disparities regarding a costly neurosurgical intervention, and ways to diminish these disparities should be further explored.

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KW - Disparities

KW - Epidemiology

KW - National analysis

KW - Outcomes

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