Surgical Timing as a Marker for Developmental Diagnoses and Behavioral Therapy Utilization in Nonsyndromic Craniosynostosis

PURPOSE: To evaluate the association between surgical timing and psychiatric and developmental diagnoses, behavioral therapy utilization, and associated financial burden in children with nonsyndromic craniosynostosis (NSC). METHODS: A retrospective cohort study was performed using the Merative MarketScan Commercial Database (2016-2022). Children with NSC were identified and stratified by surgical timing (≤12 versus >12 mo). Outcomes included disorder prevalence and behavioral therapy intensity/costs, adjusted for sociodemographics using multilevel logistic regression. RESULTS: Of the 1523 patients, 1301 (85.4%) underwent early intervention and 222 (14.6%) underwent late intervention. Late intervention (>12 mo) was a significant independent predictor of behavioral therapy utilization (OR: 2.63, 95% CI: 1.60-4.31; P<0.001). Compared with the early group, late-intervention patients utilized therapy at nearly double the rate (48.2% versus 26.1%), with significantly higher session intensity (median 25 versus 17) and costs ($2048 versus $1424, all P<0.001). Late intervention was also associated with a significantly higher prevalence of developmental (19.8% versus 11.4%, P<0.001) and psychiatric disorders (8.6% versus 4.5%, P<0.001). Multilevel regression confirmed late intervention was an independent predictor of developmental disorder diagnosis (OR: 1.88, 95% CI: 1.00-3.53, P=0.048). CONCLUSIONS: Delayed NSC repair beyond 12 months is associated with a higher prevalence of developmental diagnoses and behavioral therapy utilization. While the retrospective nature of this study precludes causal inference, these findings identify a high-risk cohort that may benefit from proactive neurodevelopmental surveillance.