From the Center for Child Health, Behavior, and Development, Seattle Children's Research Institute; Seattle Children's Hospital; and the Forsyth Institute.
Plast Reconstr Surg. 2019 Dec;144(6):1384-1391. doi: 10.1097/PRS.0000000000006254.
Surgical repair for craniosynostosis varies depending on the infant's age, location of suture fusion, and approach (e.g., open versus endoscopic). Existing data suggest possible racial and ethnic disparities in timely access to surgical care for craniosynostosis that may, in turn, be associated with surgical approach and perioperative outcomes. This study examined racial and ethnic variation in craniosynostosis operations by surgical approach and perioperative outcomes.
Data were collected by the 2013 to 2015 Pediatric National Surgical Quality Improvement Program. Patients aged younger than 24 months with diagnoses and procedure codes consistent with surgery for craniosynostosis were identified. Periprocedural characteristics and surgical approach (open, endoscopic/minimally invasive, or both) were examined descriptively, overall, and separately by race and ethnicity.
The authors identified 1982 admissions. Mean age at surgery was 7.8 ± 4.7 months. Ninety-one percent of procedures were classified as open operations, 5.8 percent were endoscopic, and 3.4 percent were both open and endoscopic. Relative to white/non-Hispanic patients, Hispanic and nonwhite patients underwent surgery at older ages, experienced longer operative and anesthesia times, and were hospitalized longer. Hispanic patients had the highest rates of open operations.
These data suggest that Hispanic and nonwhite patients tend to undergo craniosynostosis repair at older ages and to have lengthier operations than white/non-Hispanic patients. Although we were unable to examine the root cause(s) of these differences, delayed diagnosis is one factor that might result in surgery at an older age and more complex operations requiring open surgery. Prospective studies examining racial/ethnic disparities are needed to inform a comparison of outcomes associated with surgical approach.
颅缝早闭的手术修复方法因婴儿年龄、骨缝融合部位和手术入路（例如，开放手术与内镜手术）而异。现有数据表明，颅缝早闭患儿接受手术治疗的时机可能存在种族和民族差异，而这种差异可能与手术入路和围手术期结局相关。本研究通过手术入路和围手术期结局来研究颅缝早闭手术的种族和民族差异。
本研究数据来源于 2013 年至 2015 年小儿国家外科质量改进计划。研究纳入了年龄小于 24 个月、诊断和手术编码符合颅缝早闭手术指征的患者。描述性地分析了围手术期特征和手术入路（开放手术、内镜/微创手术或两者联合），并分别按种族和民族进行了分析。
作者共纳入了 1982 例患儿。手术时的平均年龄为 7.8 ± 4.7 个月。91%的手术为开放手术，5.8%为内镜手术，3.4%为开放手术联合内镜手术。与白人/非西班牙裔患者相比，西班牙裔和非白人患者的手术年龄较大，手术和麻醉时间较长，住院时间较长。西班牙裔患者的开放手术比例最高。
这些数据表明，西班牙裔和非白人患者接受颅缝早闭修复的年龄较大，手术时间较长。虽然我们无法确定这些差异的根本原因，但延迟诊断可能是导致手术年龄较大和需要行开放手术的复杂手术的一个因素。需要开展前瞻性研究来检查种族/民族差异，以比较与手术入路相关的结局。
