1Department of Neurosurgery, Penn State College of Medicine, Hershey, Pennsylvania; and.
Departments of2Neurological Surgery and.
J Neurosurg Pediatr. 2023 Jul 14;32(4):464-471. doi: 10.3171/2023.5.PEDS2335. Print 2023 Oct 1.
Although research has shown the cost-effectiveness of endoscopic versus open repair of sagittal synostosis, few studies have shown how race, insurance status, and area deprivation impact care for these patients. The authors analyzed data from children evaluated for sagittal synostosis at a single institution to assess how socioeconomic factors, race, and insurance status affect the surgical treatment of this population. They hypothesized that race and indicators of disadvantage negatively impact workup and surgical timing for craniosynostosis surgery.
Medical records of patients treated for sagittal synostosis between 2010 and 2019 were reviewed. Area deprivation index (ADI) and rural-urban commuting area codes, as well as median income by zip code, were used to measure neighborhood disadvantage. Black and White patients were compared as well as patients using Medicaid versus private insurance.
Fifty patients were prospectively included in the study. Thirty-one underwent open repair; 19 had endoscopic repair. All 8 (100%) Black patients had open repair, compared to 54.8% of White patients (p = 0.018). Black patients were more likely to use Medicaid compared to White patients (75.0% vs 28.6%, p = 0.019). White patients were younger at surgery (5.5 vs 10.0 months, p = 0.001), and Black patients had longer surgeries (147.5 minutes vs 110.0 minutes, p = 0.021). The median household income by zip code was similar for the two groups. Black patients were generally from areas of greater disadvantage compared to White patients, based on both state and national ADI scores (state: 7.5 vs 4.0, p = 0.013; national: 83.5 vs 60.0, p = 0.013). All (94.7%) but 1 patient undergoing endoscopic repair used private insurance compared to 14 (45.2%) patients in the open repair group (p = 0.001). Patients using Medicaid were from areas of greater disadvantage compared to those using private insurance by both state and national ADI scores (state: 6.0 vs 3.0, p = 0.001; national: 75.0 vs 52.0, p = 0.001).
Because Medicaid in the geographic region of this study did not cover helmeting after endoscopic repair of sagittal synostosis, these patients usually had open repair, resulting in significant racial and socioeconomic disparities in treatment of sagittal synostosis. This research has led to a change in Alabama Medicaid policy to now cover the cost of postoperative helmeting.
尽管已有研究表明内镜与开放式矢状缝颅缝早闭修复术的成本效益，但很少有研究表明种族、保险状况和地区贫困如何影响这些患者的治疗。作者分析了在单一机构接受矢状缝颅缝早闭评估的儿童的数据，以评估社会经济因素、种族和保险状况如何影响该人群的手术治疗。他们假设种族和劣势指标会对颅缝早闭手术的检查和手术时机产生负面影响。
回顾了 2010 年至 2019 年间接受矢状缝颅缝早闭治疗的患者的病历。使用区域贫困指数（ADI）和城乡通勤区代码，以及邮政编码中位数收入来衡量邻里贫困程度。比较了黑人患者和白人患者，以及使用医疗补助保险与私人保险的患者。
50 名患者被前瞻性纳入研究。31 名患者接受了开放式修复，19 名患者接受了内镜修复。所有 8 名（100%）黑人患者均接受了开放式修复，而白人患者仅为 54.8%（p = 0.018）。与白人患者相比，黑人患者更有可能使用医疗补助保险（75.0%比 28.6%，p = 0.019）。白人患者手术时年龄较小（5.5 个月比 10.0 个月，p = 0.001），黑人患者手术时间较长（147.5 分钟比 110.0 分钟，p = 0.021）。两组的邮政编码中位数家庭收入相似。黑人患者的劣势程度普遍高于白人患者，无论是基于州 ADI 评分还是国家 ADI 评分（州：7.5 比 4.0，p = 0.013；国家：83.5 比 60.0，p = 0.013）。与接受开放式修复的患者相比，所有（94.7%）但有 1 名接受内镜修复的患者使用了私人保险（p = 0.001）。使用医疗补助保险的患者的劣势程度均高于使用私人保险的患者，无论是基于州 ADI 评分还是国家 ADI 评分（州：6.0 比 3.0，p = 0.001；国家：75.0 比 52.0，p = 0.001）。
由于本研究地区的医疗补助保险不涵盖内镜修复矢状缝颅缝早闭后的头盔治疗，因此这些患者通常接受开放式修复，导致矢状缝颅缝早闭治疗方面存在显著的种族和社会经济差异。这项研究导致阿拉巴马州医疗补助政策发生变化，现在开始涵盖术后头盔治疗的费用。
