Lynn Jeremy V, Buchman Lauren K, Breuler Christopher J, Buchman Steven R
From the Section of Plastic Surgery, University of Michigan.
Plast Reconstr Surg. 2023 Apr 1;151(4):821-829. doi: 10.1097/PRS.0000000000010004. Epub 2023 Mar 29.
In 1988, Renier and Marchac asserted that children with craniosynostosis who undergo cranial vault remodeling (CVR) after 12 months of age experience delayed neurocognitive development compared to children who undergo CVR before 12 months of age. The purpose of this study was to identify factors potentially confounding this cause-and-effect relationship. The authors hypothesize that children with socioeconomic disadvantages or comorbid conditions are more likely to undergo CVR after 12 months and may represent a selection bias toward delayed neurocognitive development.
Patients with nonsyndromic single-suture craniosynostosis who underwent CVR between 2009 and 2020 at Michigan Medicine were included ( n = 227). Sociodemographic and clinical variables were documented. The sample was dichotomized to compare patients who underwent CVR before (early) and after (late) 12 months of age. Statistical analysis was performed at P < 0.05 significance.
The early and late groups contained 157 patients and 70 patients, respectively. Compared to the early group, the late group contained a larger proportion of patients who identified as non-White ( P = 0.03), qualified for need-based financial assistance ( P = 0.03), were born preterm ( P < 0.01), or had a comorbid condition ( P < 0.01). Based on preoperative testing, the late group contained a larger proportion of patients with baseline cognitive ( P < 0.001) and language ( P = 0.008) delays relative to the early group.
This study demonstrates that socioeconomic disadvantages and comorbid conditions are prevalent among patients who undergo delayed CVR and may represent a selection bias toward delayed neurocognitive development. Future studies evaluating the relationship between surgical timing and neurocognitive development must control for these factors.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
1988年，勒尼埃和马尔沙克断言，与12个月前接受颅骨重塑（CVR）的儿童相比，12个月后接受CVR的颅缝早闭儿童神经认知发育延迟。本研究的目的是确定可能混淆这种因果关系的因素。作者推测，社会经济条件差或患有合并症的儿童更有可能在12个月后接受CVR，这可能代表了对神经认知发育延迟的选择偏倚。
纳入2009年至2020年在密歇根大学医学中心接受CVR的非综合征性单缝颅缝早闭患者（n = 227）。记录社会人口统计学和临床变量。将样本分为两组，以比较12个月前（早期）和12个月后（晚期）接受CVR的患者。统计学分析的显著性水平为P < 0.05。
早期组和晚期组分别有157例和70例患者。与早期组相比，晚期组中被认定为非白人的患者比例更高（P = 0.03），符合基于需求的经济援助条件的患者比例更高（P = 0.03），早产的患者比例更高（P < 0.01），或患有合并症的患者比例更高（P < 0.01）。根据术前测试，晚期组中基线认知（P < 0.001）和语言（P = 0.008）延迟的患者比例相对于早期组更高。
本研究表明，社会经济劣势和合并症在接受延迟CVR的患者中普遍存在，可能代表了对神经认知发育延迟的选择偏倚。未来评估手术时机与神经认知发育之间关系的研究必须控制这些因素。
临床问题/证据水平：风险，II级。
