Garber Sarah T, Karsy Michael, Kestle John R W, Siddiqi Faizi, Spanos Stephen P, Riva-Cambrin Jay
Department of Neurosurgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah.
Department of Plastic Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah.
Neurosurgery. 2017 Oct 1;81(4):680-687. doi: 10.1093/neuros/nyx209.
Neurosurgical techniques for repair of sagittal synostosis include total cranial vault (TCV) reconstruction, open sagittal strip (OSS) craniectomy, and endoscopic strip (ES) craniectomy.
To evaluate outcomes and cost associated with these 3 techniques.
Via retrospective chart review with waiver of informed consent, the last consecutive 100 patients with sagittal synostosis who underwent each of the 3 surgical correction techniques before June 30, 2013, were identified. Clinical, operative, and process of care variables and their associated specific charges were analyzed along with overall charge.
The study included 300 total patients. ES patients had fewer transfusion requirements (13% vs 83%, P < .001) than TCV patients, fewer days in intensive care (0.3 vs 1.3, P < .001), and a shorter overall hospital stay (1.8 vs 4.2 d, P < .001), and they required fewer revisions (1% vs 6%, P = .05). The mean charge for the endoscopic procedure was $21 203, whereas the mean charge for the TCV reconstruction was $45 078 (P < .001). ES patients had more preoperative computed tomography scans (66% vs 44%, P = .003) than OSS patients, shorter operative times (68 vs 111 min, P < .001), and required fewer revision procedures (1% vs 8%, P < .001). The mean charge for the endoscopic procedure was $21 203 vs $20 535 for the OSS procedure (P = .62).
The ES craniectomy for sagittal synostosis appeared to have less morbidity and a potential cost savings compared with the TCV reconstruction. The charges were similar to those incurred with OSS craniectomy, but patients had a shorter length of stay and fewer revisions.
矢状缝早闭的神经外科修复技术包括全颅穹窿（TCV）重建、开放性矢状缝条状（OSS）颅骨切除术和内镜下条状（ES）颅骨切除术。
评估这三种技术的治疗效果和成本。
通过回顾性病历审查并免除知情同意，确定了2013年6月30日前连续接受这三种手术矫正技术治疗的最后100例矢状缝早闭患者。分析了临床、手术和护理过程变量及其相关的具体费用以及总费用。
该研究共纳入300例患者。与TCV患者相比，ES患者的输血需求更少（13%对83%，P<0.001），重症监护天数更少（0.3对1.3，P<0.001），总住院时间更短（1.8对4.2天，P<0.001），且需要的翻修手术更少（1%对6%，P=0.05）。内镜手术的平均费用为21203美元，而TCV重建的平均费用为45078美元（P<0.001）。与OSS患者相比，ES患者术前计算机断层扫描更多（66%对44%，P=0.003），手术时间更短（68对111分钟，P<0.001），且需要的翻修手术更少（1%对8%，P<0.001）。内镜手术的平均费用为21203美元，而OSS手术为20535美元（P=0.62）。
与TCV重建相比，用于矢状缝早闭的ES颅骨切除术似乎发病率更低，且可能节省成本。费用与OSS颅骨切除术相似，但患者住院时间更短，翻修手术更少。
