Inequities in Operative Age for Infants With Craniosynostosis

BACKGROUND AND OBJECTIVES Pediatricians conduct routine head shape evaluations with standard preventive care, and inequities in timely detection and referral of craniosynostosis (CS) patients to craniofacial clinicians may exist. Delays in CS treatment could prolong increased intracranial pressure and increase the risk of visual impairment and developmental delay. We assessed variation in timing of CS procedures by Child Opportunity Index (COI) for location of patients’ home residence. METHODS Retrospective analysis of 4828 infants with CS undergoing procedures from January 1, 2018, to December 31, 2022 in 43 US children’s hospitals in the Pediatric Health Information System (PHIS) database. Using analysis of variance, median (IQR) age in days at operation was compared with COI of patients’ home residence zip code and other patient sociodemographic characteristics. RESULTS Age at CS procedure varied significantly (P < .001) by infants’ COI, ranging from median 5 months (IQR 3–9 months) for very high COI to 8 months (IQR 4–11 months) for very low COI. Across the 43 hospitals, 8 (18.6%) demonstrated a difference of 5 months or greater in age at open operation between infants with highest vs lowest COI; 7 (16.3%) hospitals had a difference under 1 month. Among infants with very low COI, even older ages at open interventions were observed for non-Hispanic Black vs white race/ethnicity (median 10 months [IQR 7–13 months] vs median 9 months [IQR 4–12 months], P < .001). CONCLUSION Infants with low COI underwent operations for CS months later than infants with high COI. Investigation of CS care at children’s hospitals and their surrounding primary care health systems is needed to address this inequity.