Abstract：
OBJECTIVE: Disparities in insurance and socioeconomic status (SES) may impact surgical management and subsequent postoperative outcomes for patients with craniosynostosis. This systematic review summarizes the evidence on possible differences in surgical care, including procedure type, age at surgery, and differences in surgical outcomes such as complications, length of hospital stay, and child development based on SES.
METHODS: The databases Scopus, PubMed, and CINAHL were searched between May and July 2022. Following PICO criteria, studies included focused on patients diagnosed with craniosynostosis; corrective surgery for craniosynostosis; comparison of insurance, income, or zip code; and surgical management of postoperative outcomes.
RESULTS: The initial search yielded 724 articles. After three stages of screening, 13 studies were included. Assessed outcomes included: type of procedure (6 articles), age at time of surgery (3 articles), post-operative complications (3 articles), referral delay (2 articles), length of stay (2 articles), hospital costs (2 articles), and child development (1 article). Of the studies with significant results, insurance type was the main SES variable of comparison. While some findings were mixed, these studies indicated that patients with public medical insurance were more likely to experience a delay in referral, undergo an open rather than minimally-invasive procedure, and have more complications, longer hospitalization, and higher medical charges.
CONCLUSIONS: This study demonstrated that SES may be associated with several differences in the management of patients with craniosynostosis. Further investigation into the impact of SES on the management of patients with craniosynostosis is warranted to identify possible interventions that may improve overall care.
METHODS: The databases Scopus, PubMed, and CINAHL were searched between May and July 2022. Following PICO criteria, studies included focused on patients diagnosed with craniosynostosis; corrective surgery for craniosynostosis; comparison of insurance, income, or zip code; and surgical management of postoperative outcomes.
RESULTS: The initial search yielded 724 articles. After three stages of screening, 13 studies were included. Assessed outcomes included: type of procedure (6 articles), age at time of surgery (3 articles), post-operative complications (3 articles), referral delay (2 articles), length of stay (2 articles), hospital costs (2 articles), and child development (1 article). Of the studies with significant results, insurance type was the main SES variable of comparison. While some findings were mixed, these studies indicated that patients with public medical insurance were more likely to experience a delay in referral, undergo an open rather than minimally-invasive procedure, and have more complications, longer hospitalization, and higher medical charges.
CONCLUSIONS: This study demonstrated that SES may be associated with several differences in the management of patients with craniosynostosis. Further investigation into the impact of SES on the management of patients with craniosynostosis is warranted to identify possible interventions that may improve overall care.
摘要：
目的：保险和社会经济地位（SES）的差异可能会影响颅骨融合患者的手术治疗和术后结局。本系统综述总结了外科护理可能存在差异的证据，包括程序类型，手术年龄，和手术结果的差异，如并发症，住院时间,和基于SES的儿童发展。
方法：数据库Scopus，PubMed,和CINAHL在2022年5月至7月之间进行了搜索。按照PICO标准，研究包括集中于诊断为颅骨融合的患者；颅骨融合的矫正手术；比较保险，收入,或邮政编码；以及术后结果的手术管理。
结果：最初的搜索产生了724篇文章。经过三个阶段的筛选，共纳入13项研究。评估结果包括：程序类型(6篇文章)，手术时的年龄（3篇），术后并发症（3篇），转介延迟(2条)，停留时间(2条)，住院费用(2篇)，和儿童发展（1条）。在取得重大成果的研究中，保险类型是SES的主要比较变量。虽然一些发现喜忧参半，这些研究表明，有公共医疗保险的患者更有可能出现转诊延迟，接受开放而不是微创手术，并且有更多的并发症，住院时间更长，和更高的医疗费用。
结论：这项研究表明，SES可能与颅骨融合患者治疗的若干差异有关。有必要进一步研究SES对颅骨融合患者管理的影响，以确定可能改善整体护理的可能干预措施。
方法：数据库Scopus，PubMed,和CINAHL在2022年5月至7月之间进行了搜索。按照PICO标准，研究包括集中于诊断为颅骨融合的患者；颅骨融合的矫正手术；比较保险，收入,或邮政编码；以及术后结果的手术管理。
结果：最初的搜索产生了724篇文章。经过三个阶段的筛选，共纳入13项研究。评估结果包括：程序类型(6篇文章)，手术时的年龄（3篇），术后并发症（3篇），转介延迟(2条)，停留时间(2条)，住院费用(2篇)，和儿童发展（1条）。在取得重大成果的研究中，保险类型是SES的主要比较变量。虽然一些发现喜忧参半，这些研究表明，有公共医疗保险的患者更有可能出现转诊延迟，接受开放而不是微创手术，并且有更多的并发症，住院时间更长，和更高的医疗费用。
结论：这项研究表明，SES可能与颅骨融合患者治疗的若干差异有关。有必要进一步研究SES对颅骨融合患者管理的影响，以确定可能改善整体护理的可能干预措施。
