American Association of Plastic Surgeons Meeting 2022

Late Presentation of Non-Syndromic Craniosynostosis: Does Socioeconomic Status Matter?

Isabel V Lake, BS*1; Christopher D Lopez, MD*1; Alisa O Girard, MBS1; Kimberly H Khoo, MPH1; Ainsley Taylor, BS1; Joseph Lopez, MD, MBA1; Richard J Redett, MD1; Robin Yang, MD, DDS1

1Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; *Authors contributed equally

INTRODUCTION

Patients with non-syndromic craniosynostosis (NSC) generally undergo surgical management prior to 12 months of age to attenuate the surgical risks and complexities of delayed care.

Though many patients still receive primary surgery after 1 year, this cohort is poorly understood.

This study aims to identify demographic and clinical contributors to gaps in care for NSC patients who experience surgical delays.

OBJECTIVES

•Identify a cohort of NSC patients whose primary surgical repair occurred after 12 months of age

•Investigate social and clinical characteristics of this cohort

•Understand relationships between these characteristics the timeline of patient care

MATERIALS AND METHODS

Patients: A total of 699 NSC patients were identified as having primary corrective surgery at a Johns Hopkins Hospital from 1992-2022.

Variables of Interest: Demographic and clinical data, as well as care timeline and outcomes were collected via chart review.

Analysis: Linear regression was conducted for all variables with time to surgery and time from diagnosis to surgery as outcome variables.

CONCLUSIONS

Patients: n =133 of 699 NSC patients (19%) underwent surgical correction after 1 year of age (median age at surgery: 455 days)

Sociodemographic Characteristics:

•Race/Ethnicity: patients of Asian and Hispanic descent saw delays in surgery after diagnosis (496 and 194 days, respectively)

•Insurance: military insurance was associated with prolonged diagnosis-to-surgery time (~1 year)

•Family Characteristics: Surgical delays were seen in patients from immigrant families (1175 days), foster families (1002), and families with >6 children (400-765)

These results underscore the impact of familial strain in the gaps to optimal management of craniosynostosis, and indicate the influence of race in the care timeline, as Asian and Hispanic patients experienced significant delays even after receiving an appropriate diagnosis.

Clinical Characteristics:

•Affected Area: central (sagittal) and pansynostosis (>3 sutures) patients had surgical delays of 533 and 491 days, respectively

•Indication: ICP-related indications were associated with surgical delay (median of 615 days), opposite to cosmetic, functional, or image-based indications

These results align with theories of surgical delay relating to missed-diagnosis, though presence or absence of symptoms (which could aid detection) did not produce significant differences in surgical timeline.

FUTURE DIRECTIONS

Comparison to a cohort of patients who received standard craniosynostosis treatment will be needed to fully describe this delayed cohort in the context of its general population.

Further research will be needed to assess the the true impact of surgical delay on outcomes and long-term care.

American Association of Plastic Surgeons Meeting 2022

Late Presentation Of Non-syndromic Craniosynostosis: Does Socioeconomic Status Matter?

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