Comparing Outcomes and Cost of 3 Surgical Treatments for Sagittal Synostosis: A Retrospective Study Including Procedure-Related Cost Analysis

• Published in: Neurosurgery Vol. 81; no. 4; pp. 680 - 687
• Main Authors: Garber, Sarah T., Karsy, Michael, Kestle, John R.W., Siddiqi, Faizi, Spanos, Stephen P., Riva-Cambrin, Jay
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01.10.2017; Copyright by the Congress of Neurological Surgeons; Wolters Kluwer Health, Inc
• Subjects: Cost control; Endoscopy; Sagittal; Cost analysis; Craniosynostosis
• ISSN: 0148-396X; 1524-4040
• DOI: 10.1093/neuros/nyx209

Abstract BACKGROUND Neurosurgical techniques for repair of sagittal synostosis include total cranial vault (TCV) reconstruction, open sagittal strip (OSS) craniectomy, and endoscopic strip (ES) craniectomy. OBJECTIVE To evaluate outcomes and cost associated with these 3 techniques. METHODS 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. RESULTS 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). CONCLUSION 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.