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National Trends in the Treatment of Patients with Craniosynostosis: A 12 Year Review
Joseph Shin, MD1, Joshua Jacobson, MD1, Olatomide Familusi, MD1, John A. Persing, MD2.
1Montefiore Medical Center, Bronx, NY, USA, 2Yale University School of Medicine, New Haven, CT, USA.

Purpose:
No study to date has evaluated the inpatient hospitalization and resource utilization of children with craniosynostosis. This study investigates US national trends in hospitalization data and surgical repair .
Methods:
The Kid’s Inpatient Database (KID), a federal database of inpatient hospital stays for patients younger than 21 years, from 1997 to 2009 was searched using ICD-9 code 756.0 to identify all inpatient stays with a diagnosis of craniosynostosis. Demographic information, length of stay (LOS), procedures (by ICD-9 procedure code), and hospital charges were extracted and analyzed.
Results:
On average, 58.3% of patients were male. Craniosynostosis was most prevalent in Caucasians (59.7%), followed by Hispanics (20.9%) and African Americans (10.7%) (p<0.001). 65.2% of repairs were performed within the first year of life with 52.9% of those before 6 months of age. Average LOS for operative repair decreased from 4.55 days in 1997 to 4.18 days in 2009 (p=0.015). Average daily hospital charge increased from \.72 in 1997 to \.54 in 2009 (adjusted for inflation: Equivalent to 2013 dollar value) (p<0.001). On average 33.4% of cases were Medicaid covered and 60% were covered by private insurance. The proportion of Medicaid patients has increased yearly (p<0.001).
Conclusions:
Consistent with prior epidemiologic data, craniosynostosis is most prevalent in Caucasians, males, and children born in Southern states. Majority of repairs occur within the first year of life, with an average LOS of 4.18 days, and a mean daily hospitalization cost of \.72. Cost of care has risen dramatically over the past decade.


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