Endoscopic Versus Open Repair for Isolated Sagittal Craniosynostosis Before 12 Months of Age: A National Surgical Database Analysis.

BACKGROUND: Existing studies comparing endoscopic and open approaches for isolated sagittal craniosynostosis are largely limited to single-institution studies or database studies that cannot control for suture type. This study applies new diagnostic ICD-10 codes that identify suture type to investigate differences between endoscopic and open surgical approaches for patients undergoing sagittal craniosynostosis repair. METHODS: Patients younger than 12 months old undergoing repair for isolated sagittal craniosynostosis were identified in the 2023 to 2024 National Surgical Quality Improvement Program (NSQIP) Pediatric database. Demographic characteristics, clinical comorbidities, and postoperative outcomes were compared between endoscopic and open repair cases. RESULTS: The final cohort included 693 patients, with an overall 30-day postoperative complication rate of 2.3%. After matching open and endoscopic cohorts for age, BMI, and ASA class, endoscopic repair was associated with lower blood transfusion rates (20.5% versus 37.9%, P=0.003) and fewer opioid prescriptions at discharge (21.2% versus 43.2%, P<0.001), though transfusion volumes did not differ when transfusions were given (P=0.23). Operative time (P=0.068), length of stay (P=0.093), and 30-day postoperative complication (P=0.72) and reoperation (P=1.00) rates did not differ significantly between propensity score-matched groups. CONCLUSIONS: In a novel, sagittal suture-specific analysis of a national surgical database, endoscopic and open repair of isolated sagittal craniosynostosis in infants younger than 12 months demonstrated comparable short-term perioperative safety. This analysis establishes a national benchmark for short-term outcomes in sagittal synostosis repair and demonstrates the methodological value of leveraging suture-specific ICD-10 coding in large-database craniosynostosis research.