Socioeconomic Disparities in the Surgical Management of Craniosynostosis.

ABSTRACT

BACKGROUND: The updated ICD-10 coding system introduced partway through 2015 offers codes with increased granularity for disease and procedure types. This is the first study to use ICD-10 codes to investigate disparities in the surgical management for craniosynostosis. METHODS: Using the Kids' Inpatient Database univariable analyses were performed to compare the relative odds of undergoing strip craniectomy, either endoscopic (ESC) or open (OSC), or calvarial vault remodeling (CVR) based on a variety of demographic and hospital-level variables. RESULTS: Of the 2,874 patients identified, 2,352 underwent CVR while 522 underwent SC. Of those undergoing SC, 295 and 228 had an endoscopic and open procedure, respectively. A greater proportion of patients who had private insurance (58.14% versus 47.49%) or were self-pay (8.06% versus 6.28%) underwent SC, whereas a higher percentage who were covered under Medicaid (46.23% versus 32.8%; P < 0.001) received CVR. ESC patients were 2.16 times more likely to have private insurance and 2.07 times more likely to be from the highest income quartile compared to OSC patients. However, there were no differences in terms of insurance type or income level between those undergoing CVR compared to OSC. CONCLUSIONS: Our study found that the difference between CVR and SC can be attributed to the difference in the endoscopic versus open approaches to SC. Although the socioeconomic disparities persisted in the comparison between ESC and OSC, with patients receiving ESC coming from wealthier and commercially insured families, the same differences were not observed when comparing CVR with OSC.