When Timing Is Everything: Inequities in Access to Endoscopic Repair for Craniosynostosis

Background: Endoscopic repair of craniosynostosis has emerged as a common surgical option due to its minimally invasive nature and safety profile. However, its indications related to patient age necessitate early diagnosis and referral, potentially exacerbating access disparities among socioeconomically and racially marginalized populations. To evaluate demographic, socioeconomic, and hospital-related factors influencing the utilization of endoscopic versus open craniosynostosis repair in a national inpatient cohort. Methods: A retrospective analysis was conducted using the National Inpatient Sample (2018-2021). Patients undergoing craniosynostosis repair were categorized by surgical approach (endoscopic vs open). Demographic, socioeconomic, and hospital characteristics were compared using chi-square tests and binary logistic regression. Results: From a sample of 1099 patients, 183 (16.6%) underwent endoscopic repair. Endoscopic patients were significantly more likely to be under 1-year-old, White, privately insured, and from high-income zip codes ( P < .001 for all). Endoscopic procedures were more frequently performed at private, not-for-profit hospitals ( P = .029), and less frequently at government, nonfederal hospitals (adjusted P = .048). Disparities persisted in a subgroup analysis of patients under 1 year. Conclusion: Significant racial, socioeconomic, and institutional disparities exist in access to endoscopic craniosynostosis repair in the United States. These disparities persist even among clinically eligible patients, suggesting systemic barriers in early diagnosis and referral. Efforts to expand equitable access must address both social determinants and structural healthcare inequities to ensure timely, optimal care for all patients.