{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:01:29Z","timestamp":1791378089198,"version":"4.3.2"},"reference-count":18,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2024,1,18]],"date-time":"2024-01-18T00:00:00Z","timestamp":1705536000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The Cleft Palate Craniofacial Journal"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Craniosynostosis is treated with endoscopic, open, and\/or distraction surgical techniques. We assessed institutional variation in the use these techniques for craniosynostosis and compared hospital resource use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective analysis of 5249 infants age &lt;18 months old undergoing surgical procedures for all types of craniosynostosis in 2016\u20132020 in 39 freestanding children's hospitals in the Pediatric Health Information System (PHIS) database. Endoscopic vs. open cranial vault surgery (with and without distraction osteogenesis) was identified using ICD-10-CM codes. Inpatient cost and length of stay (LOS) were compared by surgery type with Wilcoxon Rank Sum.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There was significant (p\u2009&lt;\u2009.001) variation in the percentage of infants who underwent endoscopic repair across hospitals [median 23.6% (interquartile range (IQR): 7.6%\u201337.5%), range: 0% to 80.4%] and across regions [range: 22.1% (southeast) to 42.5% (northeast)]. For endoscopic procedures, median LOS and inpatient cost were lower (p\u2009&lt;\u2009.001) without vs. with distraction [1 day (IQR 1\u20131) vs. 2 days (IQR 2\u20132); $14,617 (IQR 11,823\u201322178) vs. $33,599 (IQR 22,800\u201338,619)]. For open interventions, median LOS and inpatient cost were also lower (p\u2009&lt;\u2009.001) without vs. with distraction [3 days (IQR 2\u20134) vs. 5 days (IQR 4\u20136) and $37,251 (IQR 27,114\u201350.320) vs. $62,247 (IQR 42,124\u201391,620)].<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Substantial variation in the surgical approach for craniosynostosis exists across hospitals and regions. Endoscopic repair without distraction had the lowest hospital resource use, while open repair with distraction had the highest hospital resource. Subsequent analysis of short- and long-term outcomes as well as patient-and-family costs is necessary to assess the true cost-effectiveness of each approach.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10556656241227032","type":"journal-article","created":{"date-parts":[[2024,1,19]],"date-time":"2024-01-19T01:53:45Z","timestamp":1705629225000},"page":"845-852","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":9,"title":["Hospital Variation and Resource Use for Infants with Craniosynostosis Undergoing Open, Endoscopic, and Distraction Osteogenesis Surgical Techniques"],"prefix":"10.1177","volume":"62","author":[{"given":"Melissa D.","family":"Kanack","sequence":"first","affiliation":[{"name":"Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA"},{"name":"Department of Surgery, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark R.","family":"Proctor","sequence":"additional","affiliation":[{"name":"Department of Surgery, Harvard Medical School, Boston, MA, USA"},{"name":"Department of Neurosurgery, Boston Children's Hospital, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John G.","family":"Meara","sequence":"additional","affiliation":[{"name":"Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA"},{"name":"Department of Surgery, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1201-9908","authenticated-orcid":false,"given":"Daniel M.","family":"Balkin","sequence":"additional","affiliation":[{"name":"Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA"},{"name":"Department of Surgery, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Rodean","sequence":"additional","affiliation":[{"name":"Children's Hospital Association, Lenexa, KS, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3534-9635","authenticated-orcid":false,"given":"Isabel C.","family":"Stringfellow","sequence":"additional","affiliation":[{"name":"Complex Care, Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay G.","family":"Berry","sequence":"additional","affiliation":[{"name":"Complex Care, Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA"},{"name":"Department of Pediatrics, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,1,18]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/gox.0000000000002597"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.3978\/j.issn.2224-4336.2014.07.03"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.3171\/2021.2.Peds20983"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpra.2019.01.010"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/scs.0000000000001300"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00381-018-3852-4"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.3171\/2018.5.Peds1846"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.3171\/2019.4.Peds18586"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0b013e31815c8aae"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656221085478"},{"key":"e_1_3_2_12_2","unstructured":"Quality AfHRa. Chronic Condition Indicator Refined for ICD-10-CM. www.hcup-us.ahrq.gov\/toolssoftware\/chronic_icd10\/chronic_icd10.jsp."},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0000000000003519"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0000000000008815"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.3171\/2015.4.Peds14342"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1097\/scs.0000000000004561"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656221085478"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1097\/scs.0000000000006067"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000004328"}],"container-title":["The Cleft Palate Craniofacial Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10556656241227032","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10556656241227032","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10556656241227032","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T16:21:39Z","timestamp":1777393299000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10556656241227032"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,18]]},"references-count":18,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,5]]}},"alternative-id":["10.1177\/10556656241227032"],"URL":"https:\/\/doi.org\/10.1177\/10556656241227032","relation":{},"ISSN":["1055-6656","1545-1569"],"issn-type":[{"value":"1055-6656","type":"print"},{"value":"1545-1569","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,18]]}}}