Geospatial and Socioeconomic Disparities Influencing the Management of Craniosynostosis.

BACKGROUND: Various social determinants of health have been described as predictors of clinical outcomes for the craniosynostosis population. However, literature lacks a granular depiction of socioeconomic factors that impact these outcomes, and little is known about the relationship between patients' proximity to the care center and management of the condition. METHODS/DESIGN: This study retrospectively evaluated patients with craniosynostosis who presented to a tertiary children's hospital between 2000 and 2019. Outcomes of interest included age at presentation for surgery, incidence of reoperation, and length of follow-up. Patient addresses were geocoded and plotted on two separate shapefiles containing block group information within San Diego County. The shapefiles included percent parental educational attainment (bachelor's degree or higher) and median household income from 2010. The year 2010 was chosen for the shapefiles because it is the median year of data collection for this study. Multivariate linear, logistic, and polynomial regression models were used to analyze the relationship between geospatial and socioeconomic predictors and clinical outcomes. RESULTS: There were 574 patients with craniosynostosis included in this study. The mean ± SD Haversine distance from the patient's home coordinates to the hospital coordinates was 107.2 ± 321.2 miles. After adjusting for the suture fused and insurance coverage, there was a significant positive correlation between distance to the hospital and age at index surgery (P = 0.018). There was no correlation between distance and incidence of reoperation (P = 0.266) or distance and duration of follow-up (P = 0.369). Using the same statistical adjustments, lower parental percent educational attainment and lower median household income correlated with older age at index surgery (P = 0.008 and P = 0.0066, respectively) but were not correlated with reoperation (P = 0.986 and P = 0.813, respectively) or duration of follow-up (P = 0.107 and P = 0.984, respectively). CONCLUSIONS: The results offer evidence that living a greater distance from the hospital and socioeconomic disparities including parental education and median household income may serve as barriers to prompt recognition of diagnosis and timely care in this population. However, the geospatial and socioeconomic factors studied do not seem to hinder incidence of reoperation or length of follow-up, suggesting that, once care has been initiated, longitudinal outcomes may be less impacted.

Geospatial and Socioeconomic Disparities Influencing the Management and Outcomes of Nonsyndromic Craniosynostosis: A Systematic Review.

Geospatial and socioeconomic health disparities are potential barriers to timely diagnosis and treatment of nonsyndromic craniosynostosis. This systematic review aims to assess published literature describing disparities in craniosynostosis care and to summarize the findings surrounding patient proximity to care centers and familial socioeconomic status as predictors of surgical management and outcomes. The data sources used include PubMed, MEDLINE, and Google Scholar. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used for appraisal of the quality of the studies included. Generally, the literature reviewed suggested that socioeconomic variables including race, insurance payor, and median zip code income quartile are predictors of suboptimal craniosynostosis surgical management outcomes including older age at time of surgery and more invasive surgical approach performed. The only geospatial data element assessed was the general region of the hospital where the patient was treated. The review highlighted various knowledge gaps within published literature describing health-related disparities in patients with craniosynostosis. There is a paucity of research assessing geospatial access to craniosynostosis care centers, suggesting that further research should be performed to evaluate this potential disparity. In addition, previous studies lack granularity when assessing socioeconomic factors and only one study accounted for suture fused, which is a potential confounding variable across the other published work. These considerations should be addressed in future studies addressing this topic. The limitations of this review include potential publication bias given that unpublished work was not included. An element of reviewer bias also exists considering only one reviewer screened the articles and extracted the data.

A Work in Progress: Women's Status in the Plastic Surgery Workforce and Recommendations for Success.

Only 20% of the current plastic surgery workforce is female, but since 2022 most matched applicants in integrated plastic surgery programs have been women. The aim of this study was to examine current practice models among female plastic surgeons, including those outside of academia, as the field continues to evolve. In this study we surveyed female plastic surgeons in different practice models to elicit perspectives, career path advice, characterize and project trends, and provide recommendations for success. A 37-question survey focusing on demographics, practice models, career paths, desire for practice changes, and advice for women trainees was emailed to 1342 members of the American Society of Plastic Surgeons and The Aesthetic Society. Chi square analyses compared practice type characteristics (academia, employed roles, private practice), at a significance level of .05. Response rate was 53%. Most respondents were age 35-45, in solo practice, trained in traditional pathways, without fellowships, and lacked female mentors. Private practice surgeons were very satisfied in their career, employed surgeons were moderately satisfied, and academic surgeons were mildly satisfied. Academic surgeons reported a higher number of working hours (>60) and cases per month (20-30) than employed or private practice surgeons. Recommendations for success included seeking female mentorship and enhancing business skills and building a social media platform during training. Results highlight the importance of female mentorship and acquiring business skills, and indicate private practice leads to greater career satisfaction. Training programs should consider accounting for these factors to better promote women's success and improve equity in academic practice.

Consistency of Cranial Shape Measures Obtained From Laser Surface and Computed Tomography Imaging.

OBJECTIVE: Children with cranial shape abnormalities are often subjected to radiation from computed tomography (CT) for evaluation and clinical decision making. The STARscanner Laser Data Acquisition System (Orthomerica, Orlando, FL) may be a noninvasive alternate. The purpose of this study is to determine whether the STARscanner provides valid and accurate cranial measurements compared to CT. DESIGN: We performed an institutional review board-approved retrospective review of a prospectively maintained database of patients with metopic suture abnormalities from 2013 to 2016. SETTING: Plastic surgery clinic in an institutional tertiary care center. PATIENTS: Eight patients were included that presented with metopic suture abnormalities, age less than 1 year, and CT and STARscanner imaging within 30 days of one another. MAIN OUTCOME MEASURES: Cranial measurements were collected twice from 3 scan types: STARscanner, CT windowed for soft tissue, and CT windowed for bone. Measurements included: intracranial volume, height, base width, maximum antero-posterior length, maximum medio-lateral width, and oblique diameters. Nested analysis of variance were performed to determine the proportion of error attributable to: between-subject variance, scan type, and rater. RESULTS: Measurements from STARscanner and both CT scans windows were highly consistent, with less than 1% of total error attributable to scan type for all measures. CONCLUSIONS: Cranial shape measurements obtained from STARscanner images are highly consistent with those obtained from CT scans. The STARscanner has added benefits of speed of acquisition, minimal cost, and lack of radiation.

Maximizing Patient Satisfaction in Facial Feminizing Rhinoplasty.

Background: Although facial feminizing rhinoplasty can reduce gender dysphoria, there is limited evidence on approaches to maximize transgender patient satisfaction. In a retrospective cohort of transfeminine patients who underwent feminizing rhinoplasty, we compare pre- and postoperative nasal metrics and postoperative satisfaction. Methods: Records were retrospectively reviewed to identify transfeminine patients who had feminizing rhinoplasty and cisgender females who had aesthetic rhinoplasty at least 8 weeks post-rhinoplasty. Transgender patients were contacted to rate their aesthetic and functional rhinoplasty satisfaction. Patients with 75% or greater of the total survey score were "very satisfied," those between 50% and 75% were "satisfied," and those below 50% were "less satisfied." The Vectra 3D imaging software was utilized to measure each patient's pre- and post-rhinoplasty dorsal lengths; tip projection ratios; and nasolabial, nasofrontal, and nasofacial angles. Relative percent changes for each patient between pre- and post-rhinoplasty measurements were compared between transgender and cisgender females using descriptive statistics. Results: Twenty-five transgender patients met the inclusion criteria; 19 answered the survey with 12 very satisfied, 7 satisfied, and 0 less satisfied patients. The median age of surveyed patients was 35, and 42.1% identified as Hispanic. Between very satisfied and satisfied patients, median relative percent changes in dorsal length (-1.2% vs 5.7%, P = .043), tip projection ratio (2.4% vs 8.1%, P = .038), and nasolabial angle (-2.5% vs 9.7%, P = .026) significantly differed; median relative changes in nasofrontal angles (4.2% vs -0.6%, P = .071) and nasofacial angles (-0.7% vs -3.6%, P = .703) were insignificantly different. Satisfied transgender patients and cisgender patients (n = 5) had significant differences in median relative changes in dorsal length (5.7% vs 0.7%, P = .047), tip projection ratio (8.1% vs -3.5%, P = .033), and nasolabial angles (9.7% vs -5.4%, P = .042). Very satisfied transgender and cisgender females had no significant differences in relative metric changes. Conclusions: Very satisfied transgender patients had decreases in dorsal length, smaller increases in tip projection ratio, and decreases in the nasolabial angle compared with satisfied patients. These data can help focus feminizing rhinoplasty approaches to maximize satisfaction. Further, very satisfied transgender patients had similar changes as cisgender females, reaffirming the utility of applying cisgender female rhinoplasty considerations to feminizing rhinoplasty.