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The Relationship Between Craniometric Severity and Timing of Surgery in Craniosynostosis
Andrew Salib
1, Victoria Kong
1, William Bai
1, Samira Glaeser-Khan
1, Grace Allen
1, Martin Kauke-Navarro
1, Omar Allam
1, Michael Alperovich
1
1. Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven , CT, United States.
Background: Whether objective cranial deformity severity influences the timing of presentation and surgery in craniosynostosis remains unclear. More severe deformity might be expected to prompt earlier referral; however, demographic and socioeconomic factors may also affect access to care. We evaluated the relationship between craniometric severity and timing of care in an institutional cohort.
Methods: We performed a retrospective cohort study of patients with craniosynostosis treated from 2013-2023. Craniometric severity was quantified using CranioRate-generated severity scores and percentile rankings from preoperative CT imaging. Univariate linear regression assessed associations between severity, demographic factors, and age at presentation and surgery.
Results: The study included 121 patients. There were no significant differences in craniometric severity according to race/ethnicity, sex, or insurance status (all p > 0.05). Increasing craniometric severity percentile was not associated with earlier presentation (β per 10-percentile increase, −0.27 months; p = 0.180) or earlier surgery (β, −0.35 months; p = 0.071). Greater absolute severity score similarly demonstrated only a weak trend toward earlier surgery (β per 1-point increase, −0.16 months; p = 0.095). Compared with White patients, Black patients presented 5.02 months later (p = 0.003) and underwent surgery 5.91 months later (p < 0.001). Hispanic patients underwent surgery 3.06 months later than White patients (p = 0.026), with a trend toward later presentation (β, 2.59 months; p = 0.070). Medicaid insurance was associated with later presentation (β, 2.28 months; p = 0.054) and later surgery (β, 2.58 months; p = 0.026).
Conclusions: Objective craniometric severity was only weakly associated with timing of care, whereas racial and insurance-related factors were more strongly associated with delays in presentation and surgery, suggesting persistent disparities in access to craniofacial care despite similar deformity severity.
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