ABSTRACT
Background/Purpose: Candidates for endoscopic treatment for craniosynostosis must be less than 6 months old. Given the narrow window of eligibility for endoscopic therapy, there is significant potential for barriers to health care access to impact the type of surgery a patient receives. We hypothesized that COVID may further worsen these potential disparities. Therefore this study evaluates the impact of COVID on proportion of surgeries for craniosynostosis performed open vs endoscopically based on race and ethnicity as well as socioeconomic status. Methods/Description: Charts were reviewed for children with single suture craniosynostosis from January 2014- March 2020 (pre-COVID cohort) and March 2020- September 2021 (COVID cohort). Children with syndromic craniosynostosis, significant comorbidities, or who presented after age 3 years were excluded. 110 children were in the pre-COVID group;56 were treated open and 54 endoscopically. The mean age of presentation for the endo group was 1.86 months and 10.7 months for the open group;mean age of surgery for the endo group was 2.60 months and 13.4 months for the open group. Of the 47 patients in the COVID cohort, 26 were treated endoscopically and 21 were treated open. The average age of presentation for the endo group in the COVID cohort was 1.91 months and average age of the open group was 10.6 months. Mean age at time of surgery for endoscopy in the COVID cohort was 2.66 months;mean age at time of open surgery in the COVID cohort was 12.66 months. There was no significant difference in age of presentation or age of surgery across cohorts when considering type of surgery performed. Rate of endoscopy in the pre-COVID versus COVID cohorts was not significantly different with 49% of patients in the pre-COVID cohort treated endoscopically and 55% treated endoscopically during the COVID period (P= 0.49). In both the pre-COVID and COVID cohorts there were significant differences between age of presentation, age of surgery, and type of surgery received based on race- black and Hispanic patients presented later, had surgery later and underwent open surgery more frequently than their white/Asian counterparts (P= 0.0095, P=0.0067). With respect to insurance status, in the Pre-COVID cohort 68% of patients without insurance or with Medicaid underwent open surgery and 32.6% underwent endoscopic surgery. In those with private insurance, 40.3% underwent open surgery and 59.7% had endoscopic surgery (P= 0.0071). However, there was no difference in age of presentation or type of surgery based on insurance status during COVID. The pandemic did not alter age of presentation/ age of surgery or rates of patients receiving endoscopic surgery in patients with single suture craniosynostosis. There was no relationship between insurance status and type of surgery received during the pandemic, however Hispanic and black patients continued to present later and underwent surgery at an older age compared to their white/ Asian counterparts as they did pre pandemic.