Hospital Charges and Perioperative Outcomes of Spring-Assisted Cranioplasty vs Open Cranial Vault Remodeling for Sagittal Synostosis

Objective To evaluate and compare perioperative outcomes and hospital charges between spring-assisted cranioplasty (SAC) and open cranial vault remodeling (OCVR) for single-suture craniosynostosis, with primary analysis focused on sagittal synostosis. Design Retrospective cost analysis. Setting Single tertiary academic center. Patients, Participants Patients diagnosed with single-suture craniosynostosis who underwent surgical repair between 2012 and 2024. Interventions Surgical repair via SAC or OCVR. Main Outcome Measure(s) Primary outcomes included operating room, anesthesia, intensive care unit (ICU), non-ICU, and total hospital charges. Secondary outcomes included hospital length of stay, estimated blood loss (EBL), transfusion volume, and need for subsequent craniofacial surgery. Results Analysis was restricted to sagittal synostosis to ensure cohort comparability. SAC patients were younger at surgery (3.7 ± 1.1 vs. 16.2 ± 19.2 months; p < .001) and had reduced blood donor exposure (0.86 ± 0.45 vs. 1.24 ± 0.77; p = .019) and shorter ICU (1.14 ± 0.36 vs. 1.44 ± 0.66 days, p = .029) and hospital stay (3.3 ± 0.5 vs. 5.1 ± 0.5 days; p < .001) compared with OCVR. Total EBL was similar between groups (18.8 ± 4.0 vs. 19.1 ± 2.7 mL/kg; p = .92), although blood loss at spring removal was minimal. ICU charges were lower for SAC ($3846 ± 1695 vs. $4830 ± 2428; p = .045), while operating-room, anesthesia, and total hospital charges were comparable ( p > .05). Subsequent craniofacial surgery was less frequent following SAC (6.3% vs. 35.6%; p = .003), with all SAC reoperations representing planned staged procedures. Conclusions In this institutional series of sagittal synostosis repairs, SAC was associated with lower ICU charges, fewer unique blood donor exposures, and fewer subsequent craniofacial procedures compared with OCVR. Although cumulative EBL and operative duration were similar, SAC redistributed blood loss across two shorter operations separated by several months, with minimal blood loss at removal and shorter hospitalization. These findings support SAC as a safe and efficient approach for appropriately selected infants with sagittal synostosis.