A National Assessment of Socioeconomic Disparity in Craniosynostosis

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Craniosynostosis (CS) is a common craniofacial anomaly characterized by the premature fusion of cranial sutures. CS must be surgically treated to avoid impaired brain development and an abnormally shaped skull. Surgical intervention is optimal within the first year of life to prevent long-term complications including neurological deficits, inhibition of brain growth, and increased intracranial pressure. Despite the importance of surgical intervention for all children diagnosed with CS, factors including geospatial and socioeconomic disparities are barriers to prompt recognition and timely treatment. This study aims to explore the impact of socioeconomic factors on surgical timing, postoperative outcomes, and healthcare costs on the national scale using the Healthcare Cost and Utilization Projects' (HCUP) Kids' Impatient Database (KID).

A retrospective cohort study was conducted on 10,933 pediatric patients diagnosed with CS and surgically treated from the KID national database between 2012 and 2022. Baseline demographics and outcomes were summarized using descriptive statistics, and multivariable logistic regression was used to evaluate the differences that led to delay in surgical intervention, incidence of surgical complications or re-operation, and higher surgical costs.

Mean age at admission was 1.48 ± 3.33 years (64.5% male and 35.5% female). Most patients were White (60.58%) and Hispanic (21.40%); 48.82% had private insurance and 43.28% had Medicaid. The average hospital length of stay was 3.85 days (SD=7.26), mortality of 0.05%, and mean cost of $106,074. Race was associated with total cost (P< 0.0001), with White patients having the lowest total median cost compared to Hispanic, Asian, Black, and other races. Non-private insurance was linked to higher complications/re-operation (1.22% vs. 0.71%, p= 0.0072) and higher costs ($88,127 [$52,929, $139,736] vs. $74,570 [$468,86, $120,969], p=< 0.0001) compared to privately insured patients. Geographically, re-operation rates were higher in rural areas compared to urban areas (13% vs. 0.94%, p=< 0.0001). Lower household income, quartile defined by zip code, was associated with higher rates of complications and re-operations (Q1=1.56%, Q2=1.09%, Q3=0.69%, and Q4=0.62%; p=0.0017) with Q1 vs. Q4 odds ratio of 2.3 [1.255-4231].

This study highlights the socioeconomic and geographic disparities that influence CS surgical outcomes, including complications, re-operation, length of hospitalization, and total costs. These findings suggest that addressing systemic barriers while having a standardized treatment protocol are opportunistic areas to improve post-surgical outcomes and decrease the financial burden in the treatment of patients with CS nationwide.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2115

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