Surgical Timing and Postoperative Outcomes of Craniosynostosis Repair by Race When Stratified by Suture Type

BACKGROUND: Prompt surgical repair of craniosynostosis has been recommended to reduce neurological sequelae and morbidity. Socioeconomic disparities may affect surgical timing, but their effect has not been adequately separated from clinical factors in prior database studies. This study incorporates new diagnostic codes to investigate the effect of race on surgical timing and postoperative outcomes while stratifying for comorbidities and suture involvement. METHODS: All craniosynostosis repair surgeries with specified suture involvement were identified in the 2023 and 2024 National Surgical Quality Improvement Program Pediatric database. A multivariable logistic regression model was used to assess the impact of race on delayed surgical timing, defined as age >12 months at surgery. White and Black patient cohorts were then matched on comorbidities and surgical factors, and postoperative outcomes were compared in the matched cohorts. RESULTS: The final cohort included 1520 patients with delayed surgical timing observed in 317 (20.9%) cases. When controlled for comorbidities and suture type, Black race was associated with increased odds of delayed surgical timing (OR: 2.84, 95% CI: 1.53-5.29, P<0.001). After matching for comorbidities, suture type, and surgical approach, Black patients were associated with significantly higher rates of postoperative complications when compared with White patients (9.6% versus 1.2%, P=0.040). CONCLUSION: After controlling for clinical comorbidities and suture involvement, Black race was associated with delayed surgical timing and higher rates of postoperative complications in craniosynostosis repair, reinforcing the clinical impact of health disparities in craniosynostosis care.