Vogel Timothy W, Woo Albert S, Kane Alex A, Patel Kamlesh B, Naidoo Sybill D, Smyth Matthew D
Department of Neurosurgery and.
J Neurosurg Pediatr. 2014 Mar;13(3):324-31. doi: 10.3171/2013.12.PEDS13320. Epub 2014 Jan 10.
The surgical management of infants with sagittal synostosis has traditionally relied on open cranial vault remodeling (CVR) techniques; however, minimally invasive technologies, including endoscope-assisted craniectomy (EAC) repair followed by helmet therapy (HT, EAC+HT), is increasingly used to treat various forms of craniosynostosis during the 1st year of life. In this study the authors determined the costs associated with EAC+HT in comparison with those for CVR.
The authors performed a retrospective case-control analysis of 21 children who had undergone CVR and 21 who had undergone EAC+HT. Eligibility criteria included an age less than 1 year and at least 1 year of clinical follow-up data. Financial and clinical records were reviewed for data related to length of hospital stay and transfusion rates as well as costs associated with physician, hospital, and outpatient clinic visits.
The average age of patients who underwent CVR was 6.8 months compared with 3.1 months for those who underwent EAC+HT. Patients who underwent EAC+HT most often required the use of 2 helmets (76.5%), infrequently required a third helmet (13.3%), and averaged 1.8 clinic visits in the first 90 days after surgery. Endoscope-assisted craniectomy plus HT was associated with shorter hospital stays (mean 1.10 vs 4.67 days for CVR, p < 0.0001), a decreased rate of blood transfusions (9.5% vs 100% for CVR, p < 0.0001), and a decreased operative time (81.1 vs 165.8 minutes for CVR, p < 0.0001). The overall cost of EAC+HT, accounting for hospital charges, professional and helmet fees, and clinic visits, was also lower than that of CVR ($37,255.99 vs $56,990.46, respectively, p < 0.0001).
Endoscope-assisted craniectomy plus HT is a less costly surgical option for patients than CVR. In addition, EAC+HT was associated with a lower utilization of perioperative resources. Theses findings suggest that EAC+HT for infants with sagittal synostosis may be a cost-effective first-line surgical option.
矢状缝早闭婴儿的手术治疗传统上依赖于开放性颅穹隆重塑（CVR）技术；然而，微创技术，包括内镜辅助颅骨切除术（EAC）修复后进行头盔治疗（HT，EAC+HT），在1岁以内越来越多地用于治疗各种形式的颅缝早闭。在本研究中，作者确定了EAC+HT与CVR相关的成本。
作者对21例接受CVR的儿童和21例接受EAC+HT的儿童进行了回顾性病例对照分析。纳入标准包括年龄小于1岁且至少有1年的临床随访数据。审查财务和临床记录，以获取与住院时间、输血率以及与医生、医院和门诊就诊相关的成本的数据。
接受CVR的患者平均年龄为6.8个月，而接受EAC+HT的患者平均年龄为3.1个月。接受EAC+HT的患者最常需要使用2个头盔（76.5%），很少需要第三个头盔（13.3%），术后前90天平均门诊就诊1.8次。内镜辅助颅骨切除术加HT与住院时间缩短相关（EAC+HT组平均为1.10天，CVR组为4.67天，p<0.0001），输血率降低（EAC+HT组为9.5%，CVR组为100%，p<0.0001），手术时间缩短（EAC+HT组为81.1分钟，CVR组为165.8分钟，p<0.0001）。EAC+HT的总成本，包括医院收费、专业费用、头盔费用和门诊就诊费用，也低于CVR（分别为37255.99美元和$56990.46，p<0.0001）。
对于患者来说，内镜辅助颅骨切除术加HT是一种比CVR成本更低的手术选择。此外，EAC+HT的围手术期资源利用率较低。这些发现表明，对于矢状缝早闭的婴儿，EAC+HT可能是一种具有成本效益的一线手术选择。
