Variation in the Utilization of Postoperative Computed Tomography for Patients With Nonsyndromic Craniosynostosis: A National Claims Analysis
Variation in the Utilization of Postoperative Computed Tomography for Patients With Nonsyndromic Craniosynostosis: A National Claims Analysis
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DOI：
10.1177/1055665619882568
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发表时间：
2020-03-01
期刊：
影响因子：
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通讯作者：
Buchman, Steven R.
中科院分区：
文献类型：
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作者：
Bennett, Katelyn G.;Gunaseelan, Vidhya;Buchman, Steven R.
目的：由于放射暴露的危害，非综合征性颅缝早闭的术后常规CT成像仍然存在争议。术后进行头部CT检查的程度尚不清楚。因此，我们试图衡量术后CT在这一人群中的使用情况。设计：作者回顾了OpumInsight的保险索赔，使用当前的程序术语代码来确定程序和术后成像。多水平Logistic回归用于描述术后接受CTS的几率，调整了患者和提供者的协变量。参与者：回顾2001至2017年间接受重建的颅突融合患者。结果：在本队列中，326例(28.4%)患者接受了术后头部CT检查。手术年龄大(优势比：1.32，P=.002)、随访年限增加(OR：1.12，P<；.001)、合并并发症增多(OR：1.21，P=.017)与术后CT有关。在调整了患者因素后，提供者因素解释了影像变异的31.3%。结论：超过四分之一的患者在重建后接受了头部CT检查，提供者因素解释了很大比例的变异。考虑到辐射的风险，神经外科医生和颅面外科医生面临着建立术后成像方案的迫切需要，以减少这些脆弱患者的不必要成像。
Objective:Routine postoperative computed tomography (CT) imaging in nonsyndromic craniosynostosis remains controversial due to the hazards of radiation exposure. The extent to which postoperative head CTs are performed remains unknown. Therefore, we sought to measure the use of postoperative CTs in this population.Design:The authors reviewed insurance claims from OptumInsight, using Current Procedural Terminology codes to identify procedures and postoperative imaging. Multilevel logistic regression was used to describe the odds of undergoing postoperative CTs, adjusting for patient and provider covariates.Participants:Craniosynostosis patients who underwent reconstruction between 2001 and 2017 were reviewed. Patients older than 5 years at surgery, postoperative lengths of stay >15 days, syndromic diagnoses, operative complications within 30 days of surgery, and cranial bone grafting merited exclusion.Main Outcome Measure:Odds of postoperative head CTs after cranial vault reconstruction.Results:In this cohort (n = 1150), 326 (28.4%) patients underwent postoperative head CTs. The number of CTs ranged from 0 to 14. Older age at surgery (odds ratio [OR]: 1.32, P = .002), increasing years of follow-up (OR: 1.12, P < .001), and increasing comorbidities (OR: 1.21, P = .017) were associated with postoperative CTs. After adjusting for patient factors, provider factors accounted for 31.3% of variation in imaging.Conclusions:Over a quarter of patients underwent head CTs following reconstruction, and provider factors accounted for a large percentage of the variation. Given the risks of radiation, neurosurgeons and craniofacial surgeons face a critical need to establish postoperative imaging protocols to reduce unnecessary imaging in these vulnerable patients.