Age at Surgery Associated With Increased Expressive Language Delays in Children With Single Suture Craniosynostosis

INTRODUCTION: This study evaluated overall expressive language delays in craniosynostosis and whether age at surgery is associated with expressive language delays in this cohort. METHODS: The authors conducted a retrospective cohort study of patients with single-suture craniosynostosis treated at a single academic center between 2012 and 2023. Patients with documented expressive language delays by a speech-language pathologist were identified. Patients with syndromic craniosynostosis, genetic syndromes, cleft palate, hearing loss, or other anatomic or neurological conditions affecting language or speech were excluded. The average age at surgery was compared between single-suture craniosynostosis patients with and without expressive language delays. Multivariable logistic regression was used to evaluate the association between age at surgery (modeled as a continuous variable in months) and expressive language delay, adjusting for suture type and social vulnerability index (SVI). RESULTS: A total of 107 patients met the inclusion criteria. 14 of 107 (13.1%) patients had documented expressive language delays. Mean age at surgery for patients without expressive language delays was 6.8 months versus 11.9 months for those with expressive language delays (P=0.038). On multivariable regression, increasing age at surgery was independently associated with higher odds of expressive language delay, with each 1-month increase corresponding to a 15% increase in odds (OR: 1.15, 95% CI: 1.04-1.28; P=0.007), after adjusting for suture type and SVI. CONCLUSIONS: Patients with single-suture craniosynostosis had an elevated burden of expressive language delays. In addition, later age at surgery was associated with higher rates of expressive language delays. These findings emphasize the importance of early developmental surveillance.