The association between greater age at surgery and increased developmental delays and therapy burden in craniosynostosis.

Abstract

Objective: Children with nonsyndromic craniosynostosis (NSC) are at risk for neurodevelopmental delays that often require rehabilitative therapies. Early surgical intervention (before 12 months of age) is believed to support more normal brain development, but prior studies have been constrained by small cohorts and limited follow-up. This study provides the first national, longitudinal analysis of the relationship between age at surgery and subsequent therapy utilization.

Methods: The authors performed a retrospective cohort study using the Merative MarketScan commercial database (2016-2022). Children with NSC who underwent cranial surgery were identified and stratified by timing of intervention (≤ vs > 12 months). Patients older than 3 years were excluded for surgery, in addition to those with comorbid neurological and genetic conditions. Outcomes included use of speech, occupational, and physical therapy, as well as gross provider payments. A multilevel logistic regression analysis assessed associations between surgical timing, Pediatric Comorbidity Index scores, sex, sociodemographic factors, and therapy utilization.

Results: Among 1523 patients with a median follow-up of 4 (interquartile range 2-8) years, 28.6% received speech therapy, 34.9% occupational therapy, and 30.1% physical therapy; 1301 patients (85.4%) underwent surgery under 1 year of age while 222 patients (14.6%) underwent surgery between 1 and 3 years of age. Patients undergoing later surgery had markedly higher therapy utilization across all domains, i.e., speech (48.2% vs 25.3%), occupational (56.3% vs 31.2%), and physical therapy (51.8% vs 26.4%; all p < 0.001). The median number of sessions and payments were also significantly greater in the late cohort for occupational and physical therapy. On multilevel regression, surgery after 12 months was independently associated with increased odds of therapy use (speech OR 1.72, occupational OR 1.61, and physical OR 1.55; all p < 0.05). Patients undergoing surgery after 12 months also had significantly higher rates of developmental delay, including speech delay (40.1% vs 28.1%), motor delay (20.7% vs 9.1%), and global delay (26.6% vs 7.8%) compared with those treated at ≤ 12 months (all p < 0.001).

Conclusions: Children undergoing surgery for NSC after 12 months of age demonstrated higher rates of documented developmental delay diagnoses and greater use of rehabilitative services. This work supports multidisciplinary rehabilitative therapy in the long-term management of children with craniosynostosis.