Age-Based Disparities in Outcomes of Pediatric Craniosynostosis Surgical Management

Introduction: Craniosynostosis, the premature fusion of cranial sutures in pediatric patients, necessitates surgical intervention to address cranial growth restrictions and help prevent neurological deficits. However, surgical management can lead to rehospitalization, deficits, infection, and reoperation. This study explores these factors to inform tailored approaches based on age and surgical techniques. It also highlights the imperative for an in-depth investigation into specific outcomes to enhance our understanding of craniosynostosis management.

Methods: This study employed the TriNetX online health record database to retrospectively compare outcomes across pediatric patients diagnosed with craniosynostosis (ICD-10-CM diagnosis code of Q75.0) who underwent surgical repair. Cohort 1 (n=4,319) comprised pediatric patients ≤ 1 year of age, while Cohort 2 (n=3695) comprised pediatric patients 1-2 years of age. Propensity score matching yielded 955 patients in each cohort for comparison. The outcomes explored were death, deficits (psychomotor, cognitive communication deficit, visuospatial deficit, other cognitive deficits, and attention and concentration deficit), rehospitalization, cerebrospinal fluid leakage (CSF leak), infection, and reoperation. The time window for outcomes analysis included any time after the operation for craniosynostosis.

Results: Patients in Cohort 1 had a significantly higher rate of rehospitalization (p < 0.0001) and infection within 3 months of surgery (p=0.0105) compared to patients in Cohort 2. There was no significant difference in death (p=1.000), deficits (p=0.9935), CSF leakage (p=1.000), or reoperation (p=1.000).

Conclusion : Our results indicate that patients ≤ 1 year of age who undergo an operation for craniosynostosis may be at an increased risk of subsequent rehospitalization and post-operative infection compared to patients 1-2 years of age. These findings underscore the importance of tailoring treatment approaches according to age and surgical procedures and emphasize the necessity of further research to improve the management of craniosynostosis.