Ritchey, Andrew

Objective To compare perioperative outcomes, complications, imaging utilization, and device management following posterior vault distraction osteogenesis (PVDO) and spring-mediated cranioplasty (SMC) for multisutural craniosynostosis. Design Retrospective cohort study. Setting Single pediatric tertiary care center. Patients, Participants Twenty-three patients with multisutural craniosynostosis treated between 2017 and 2025 (PVDO, n = 18; SMC, n = 5). Interventions PVDO or SMC. Main Outcome Measure(s) Time to device removal, imaging utilization, reoperations, readmissions, device-related complications, revision surgeries, wound infections, and absolute intracranial volume change. Results PVDO was associated with earlier device removal than SMC (78.7 ± 22.1 vs. 133.0 ± 27.4 days; P = .0015) but greater postoperative imaging utilization during the first year (5.33 ± 1.28 vs. 2.80 ± 1.64 studies; P = .01). Rates of reoperation (22.2% vs. 0%), readmission (22.2% vs. 40.0%), device-related complications (11.1% vs. 0%), revision surgery (16.7% vs. 0%), and wound infection (22.2% vs. 20.0%) did not differ significantly (all P ≥ .50). Preoperative imaging utilization and postoperative intracranial volume gain were comparable between groups. Conclusions PVDO and SMC demonstrated similar safety profiles and intracranial volume expansion in patients with multisutural craniosynostosis. Compared with SMC, PVDO enabled earlier device removal but required increased postoperative imaging. These findings may inform operative planning, postoperative surveillance, and family counseling. Larger, multicenter studies with longer follow-up are needed to evaluate long-term outcomes.

ABSTRACT Objectives The purpose of this study is to compare the economics of in‐office tympanostomy tube placement using single use devices versus standard placement in the operating room (OR). Methods A retrospective chart review was completed for all pediatric patients who underwent in‐office tympanostomy tube placement (CPT 69433) along with insurance and date matched patients with placement in the OR (CPT 69436) between 12/1/21–3/1/24. Financial data were compared among the public vs. private insurance cohorts using the Wilcoxon rank‐sum test with a two‐sided significance level of 5%. Results One hundred and thirty‐six in‐office patients were identified, 102 private versus 34 public, and compared with 136 insurance and date matched OR patients. The average total payment for both privately insured patients, $647.14 in‐office versus $6873.45 in the OR, and publicly insured patients, $312.74 in‐office versus $2656.34 in the OR, was statistically significant. The average insurance payment for both privately insured patients, $301.58 in‐office versus $5445.73 in the OR, and publicly insured patients, $310.63 in‐office versus $2258.65 in the OR, was statistically significant. For the patient payment, public insurance usually has 0 copay and is therefore excluded. The patient payment of the private insurance cohort, $308.30 in‐office versus $670.61 in the OR, was not found to be statistically significant. Conclusion As expected, this study demonstrates significant reductions in overall cost with in‐office tympanostomy tube placement even with the added cost of single‐use devices compared to the standard placement in the OR, particularly for insurance companies, suggesting the potential benefit of providing reimbursement for these devices. Level of Evidence N/A.