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INTRODUCTION: Favorable behavioral interactions are critical for academic and interpersonal success. An association between metopic synostosis and behavioral impairments has not been fully elucidated. Behavioral dysfunction in school age children with surgically corrected metopic synostosis was evaluated using targeted testing to detect the most common behavioral abnormalities in this population. METHODS: Parents of children 6-18 years old with metopic synostosis completed the Conners Short 3 rd edition (Conners-3: ADHD), Social Responsiveness Scale 2 nd edition (SRS-2: autism spectrum disorder), Behavior Rating Inventory of Executive Function 2 nd edition (BRIEF-2: executive functioning), and Child's Behavioral Checklist (CBCL: behavioral/emotional functioning). Children also completed neurocognitive testing. Multivariable regression was used to determine predictors of clinically significant behavioral impairments. RESULTS: 60 children were enrolled. Average age at surgery was 9.2 ± 7.9 months, with an average age at assessment of 10.3 ± 3.5 years. Nearly half of patients demonstrated symptoms associated with ADHD, demonstrated by reaching or exceeding borderline clinical levels for inattention and hyperactivity subscales of the Conners-3. Greater age at surgery was associated with worse executive function, measured by reaching or exceeding clinically significant levels of the executive function subscale of the Conners-3 (p=0.04) and subscales of the BRIEF-2 (behavioral regulator index [p=0.05], cognitive regulatory index [p=0.03], and global executive composite [p=0.04]). CONCLUSIONS: Nearly half of patients with surgically corrected metopic synostosis reached borderline clinical scores for inattention and hyperactivity. Greater age at surgery was associated with worse executive function. Prompt surgical correction of metopic synostosis may portend improved long-term emotional and behavioral function.
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BACKGROUND: Office-based surgery can increase logistical and financial efficiency for patients and surgeons. The current study compares wide-awake office-based carpal tunnel release to wide-awake surgeries performed in the operating room (OR) in terms of volume, financial burden, narcotic prescriptions, and adverse events. METHODS: Surgeries performed under local-only anesthesia from 2010 to 2020 were identified in a national administrative database (PearlDiver™). Patients were grouped by surgical setting and matched based on age, sex, comorbidity burden, and geographic region. Primary endpoints included total disbursement and physician reimbursement, as well as 30-day narcotics prescriptions, emergency department (ED) visits, and surgical site infections (SSI). RESULTS: Before matching, there were 303,741 OR surgeries and 5,463 office surgeries. From 2010 to 2020, the percent of surgeries in the office increased from 1.2% to 3.4%. Matched cohorts included 21,835 OR surgeries and 5,459 office surgeries. Office surgery was associated with lower total disbursement and physician reimbursement for patients with commercial insurance, Medicaid, and Medicare. Linear regression modeling indicated that office-based surgery was significantly associated with lower total disbursement and physician reimbursement. Fewer office patients filled narcotic prescriptions and visited the ED, and there was no difference in SSI. CONCLUSION: Compared to OR surgery, office surgery was associated with lower financial burden, fewer narcotics prescriptions and ED visits, and similar incidence of SSI. These findings, together with literature showing greater efficiency in the office, suggest that office-based surgeries are safe and cost-effective and should continue to grow.