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Disparities in Access to Endoscopic and Open Approaches to the Surgical Management of Craniosynostosis: A Large, National Cohort Evaluation
Daniel Y. Kwon
1, Allison Choe
1, Dillan Villavisanis
1, Olachi Oleru
1, Nargiz Seyidova
1, Peter Shamamian
1, Carol Wang
1, Alex J. Sarosi
1, Peter J. Taub
1
1Icahn School of Medicine at Mount Sinai, New York, NY, United States.
Background: Despite advancements in surgical interventions for craniosynostosis, significant disparities in access to specialized care persist. The purpose of this study was to report disparities in endoscopic and open approaches to the treatment of craniosynostosis using a large, national database.
Methods: A database retrospective cohort study was conducted using the 2018, 2019, 2020, and 2021 National Inpatient Sample (NIS). Discharge information was obtained for patients who fulfilled both a primary diagnosis for craniosynostosis (ICD-10: Q75.0) as well as ICD-10 PCS classification for related surgical management in the same admission.
Results: A total of 1,099 patients received surgical management for craniosynostosis after admission: 183 (16.7%) were treated endoscopically and 916 (83.3%) were treated with open surgery. Significantly more patients had private insurance in the endoscopic group (60.1%) compared to the open group (37.7%, p<0.001). There were significantly more White patients within the endoscopic group (67.8%) than the open group (48.6%, p<0.001). Furthermore, there were significantly more patients residing within the 76th-100th percentile of median household income zip codes in the endoscopic group (37.2%) compared to the open group (24.6%, p<0.001). Lastly, there were significantly more patients treated at private, not for profit hospitals within the endoscopic group (93.4%) than the open group (87.9%, p=0.029).
Conclusion: This study reveals notable demographic and socioeconomic disparities between patients undergoing endoscopic and open surgical treatment for craniosynostosis, which may impact equitable healthcare and outcomes.
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