175. Cost Comparison Between Spring-assisted Cranioplasty and Open Cranial Vault Remodeling as the Primary Surgical Management of Single-suture Craniosynostosis

PURPOSE: Spring-assisted cranioplasty (SAC) has been shown to decrease operative time, intraoperative blood loss, and postoperative hospital stay when compared to open procedures. Also, endoscopic strip craniectomy with helmeting has been shown to be less costly overall than open procedures. However, it is unknown if this is also true with SAC which requires a second surgery for spring removal. The goal of this study is to provide a financial comparison between spring-assisted cranioplasty and other open surgical procedures for the treatment of single-suture craniosynostosis. METHODS: Following Institutional Board Review approval, a retrospective review was conducted on all patients diagnosed with single-suture craniosynostosis between 2012-2024. Charges were analyzed for operating room (OR), anesthesia, intensive care unit (ICU) stay, non-ICU stay, and total overall costs along with other surgical data. Costs were adjusted for inflation utilizing Consumer Price Index codes provided by the US Bureau of Labor. Expenses for patients with single-suture craniosynostosis who underwent SAC (n=36) were compared to those who underwent open cranial vault remodeling procedures (n=103) such as fronto-orbital advancement (n=57), posterior vault distraction osteogenesis (n=2), posterior cranial vault remodeling (n=19), pi-plasty (n=21), or total cranial vault remodeling (n=4). Independent t-tests were utilized with the significance value of 0.05. RESULTS: The total overall cost of treatment for patients undergoing SAC was over $13,500 less than those undergoing open procedures (p=0.05). Patients undergoing SAC also had shorter total hospital length of stay (2.97 days versus 5.09 days, p<0.01) and ICU length of stay (25.44 hours vs 30.65, p<0.02). There was no significant difference in the cost of hospital stay between groups likely due to the additional post anesthesia care unit expenses for spring removal which was added to the hospital stay average. Although the time spent in the ICU was shortened between the subgroups, the difference was not reflected in the cost analysis as ICU stays are charged per diem. Individual procedure length was also lower in patients undergoing SAC (1.90 hours vs 3.35 hours, p<0.01), along with blood loss and blood replacement (108.44 mL and 117.94 vs 237.91 mL and 281.57 mL, respectively, p<0.01). CONCLUSION: This study shows that when compared to open procedures for single-suture craniosynostosis, SAC can decrease overall costs of care, hospital and ICU length of stay, procedure length, and blood loss.