Open Versus Endoscopic Craniosynostosis Repair by Age Category: A Propensity Score-Matched Registry Study

Objective To compare effectiveness, safety, and clinical outcomes between age-defined endoscopic and open craniosynostosis repair cohorts. Methods We queried the NSQIP database for patients with craniosynostosis (ICD-10 Q75.0) who underwent craniectomy. Since Current Procedural Terminology (CPT) codes do not distinguish operative approach, age was used as a surrogate: patients aged ≤4 months were classified as endoscopic and those aged 6-12 months as open; patients aged >4 to <6 months were excluded. Outcomes included operative time, hospital length of stay (LOS), transfusion, and postoperative complications. Results A total of 1945 patients aged 4 months or younger were classified in the endoscopic cohort, while 2033 patients aged 6 to 12 months were classified in the open cohort. Neurosurgeons performed the procedure most often, with 2663 cases (66.9%). 98.9% were elective, and inpatient cases were the most common, accounting for 94.8%. The median total LOS in days was 1.0 for endoscopic and 3.0 for open procedures, which were statistically significantly different ( P < 0.001). Surgical site infection was not significantly different in our study ( P = 0.11). The need for transfusion was significantly different, favoring the endoscopic cohort ( P < 0.001). Conclusions In this age-defined comparison, the endoscopic cohort had shorter operative time and hospital stay and a lower transfusion requirement than the open cohort. Because operative approach was inferred from age rather than directly identified by CPT code, these findings should be interpreted as associations between age-defined cohorts rather than definitive procedure-specific effects.