A Decade of Craniosynostosis Surgery in the United States: Trends in Management, Payer Mix, and Cost.

BACKGROUND

Cranial vault remodeling (CVR) and endoscopic strip craniectomy (SC) are principal operations for nonsyndromic craniosynostosis. Over the past decade, evolving minimally invasive techniques and shifting payer landscapes may have influenced national practice patterns. We evaluated trends in surgical utilization, payer mix, and cost across US children's hospitals from 2016 to 2025.

METHODS

A retrospective analysis of the Pediatric Health Information System identified infants with craniosynostosis who underwent CVR or SC between 2016 and 2025 using ICD and CPT codes. Demographics, payer type, and inflation-adjusted cost were compared. Annual trends in utilization, payer mix, and cost were analyzed with linear regression.

RESULTS

Among 15,335 infants, 13,329 underwent CVR and 2006 SC. Strip craniectomy patients were younger (95 versus 280 d, P <0.001), more often male (70.8% versus 64.7%, P <0.001), from higher-income households (median $46,124 versus $42,374, P <0.001), and had a higher proportion of privately insured patients (62.1% versus 47.4%, P <0.001) and a lower proportion of Black children (3.1% versus 8.4%, P <0.001). Strip craniectomy use increased from 8.8% to 20.2% of procedures (β=1.23%/yr, P <0.001). Strip craniectomy cost rose from $14,990 to $21,660 (+$632/yr, P =0.002). Medicaid coverage increased among SC patients (27.0%-39.6%, β= +1.27%/yr, P <0.001) but decreased among CVR patients (48.6%-45.8%, β= -0.40%/yr, P =0.038).

CONCLUSIONS

From 2016 to 2025, craniosynostosis care shifted toward increased use of minimally invasive strip craniectomy, accompanied by rising SC costs and greater Medicaid representation. Despite these changes, sociodemographic disparities in access to early, minimally invasive repair persist. These findings provide national benchmarks for utilization, payer patterns, and cost to guide clinical practice and policy.