Leveraging novel diagnostic codes for craniosynostosis by suture type in surgical database research

Background

Craniosynostosis presents with a diverse range of presentations that influence surgical approach and postoperative outcomes. This study applies new diagnostic ICD-10 codes that stratify by craniosynostosis suture type to investigate trends in postoperative outcomes within a surgical database.

Methods

Patients undergoing craniosynostosis repair with specified suture types were identified in the 2023 National Surgical Quality Improvement Program (NSQIP) Pediatric database. Cases were characterized by clinical comorbidities and age at presentation. The outcome of interest was 30-day complications, including infection, reoperation, and blood transfusion, as well as the reception of endoscopic versus open repair.

Results

The final cohort included 336 patients. The most common suture type was sagittal (52.7%), followed by metopic (20.2%). The rate of opioid prescriptions at discharge was 41.4%. Rates of 30-day complications were highest in unicoronal craniosynostosis (12.1%), and rates of endoscopic repair were highest in sagittal craniosynostosis (16.4%) (p<0.001). When comparing single-suture to multisuture involvement, the latter was associated with older age at repair (32.6±35.8 vs. 13.0±24.1 months, p=0.011) and longer operative time (3.7±1.3 vs. 2.7±1.7 h, p=0.0013). Rates of thirty-day complications and opioid prescriptions at discharge were not significantly different between the two cohorts (p>0.05).

Conclusion

The release of new diagnostic codes has allowed for the confirmation of known trends, such as the prevalence of different suture types and the relative safety of craniosynostosis repair with respect to short-term complications, as well as the identification of areas for further exploration, such as national trends in postoperative opioid prescriptions, within craniosynostosis research.