Socioeconomic and geographic factors associated with the timing of surgical intervention for sagittal craniosynostosis in Georgia.

OBJECTIVE

Nonsyndromic sagittal craniosynostosis is the most common form of craniosynostosis, and its management includes open cranial vault reconstruction (CVR) or minimally invasive techniques such as endoscopic suturectomy with helmet orthosis (ESO) and spring-assisted suturectomy (SAS). Delayed surgical referral can limit eligibility for minimally invasive techniques, which are associated with lower morbidity. Disparities in socioeconomic factors may contribute to later presentation, particularly for minority populations. This study explores the impact of sociodemographic variables, Area Deprivation Index (ADI), and Child Opportunity Index (COI) on referral timing, surgical timing, and the type of intervention performed.

METHODS

The authors performed a retrospective review of children who underwent surgery for nonsyndromic single-suture sagittal craniosynostosis at a large urban referral center between 2015 and 2023. Patients were categorized into earlier referral (< 2 months) or later referral (≥ 2 months) cohorts and earlier surgery (< 6 months) or later surgery (≥ 6 months) cohorts. Demographics, socioeconomic indices (ADI, COI), and procedure type were compared between groups.

RESULTS

Two hundred four children, 29.4% of whom were female, met the study inclusion criteria. Among these children, 50.0% underwent CVR, 36.3% SAS, and 13.7% ESO. Patients in the later surgery cohort were significantly more likely to be non-White (29.1%, p < 0.01), non-English speaking (13.9%, p < 0.01), and publicly insured or uninsured (59.5%, p < 0.01). Non-White patients were referred later (93 vs 45 days, p < 0.001), disproportionately older at surgery (207 vs 148 days, p < 0.001), and more likely to undergo CVR (69.2%, p < 0.001). Distance to the hospital, median household income, ADI, and COI were not significant predictors of the type of surgery performed.

CONCLUSIONS

This study highlights disparities in access to minimally invasive craniosynostosis surgery, particularly among non-White, non-English speaking, and socioeconomically disadvantaged children in the state of Georgia. Targeted efforts in community education are needed to reduce this disparity and strive toward equitable access to care.