Clinical Practice Patterns in Nonsyndromic Craniosynostosis: A Review of Continuous Certification Tracer Data From the American Board of Plastic Surgery

Since 2003, the American Board of Plastic Surgery has collected data on 20 plastic surgery operations as part of the Maintenance of Certification process. The goal of this study was to describe national trends in craniosynostosis repair as they relate to Evidence-Based Medicine (EBM) articles published during this timeframe. Cumulative tracer data for nonsyndromic craniosynostosis were reviewed from 2006 to March 2020, and compared with EBM articles published in Plastic and Reconstructive Surgery. Topics were categorized as: (1) pearls, addressed in both the tracer data and EBM articles, (2) topics only addressed in EBM articles, and (3) topics only addressed in tracer data. As of March 2020, 940 cases of nonsyndromic craniosynostosis had been entered. The median age at the time of surgery was 8months (range, 1-204months). Practice patterns from 2006 through 2013 were compared with those between 2013 and 2020. The most common surgical technique from 2006 through 2013 was anterior regional cranioplasty, and from 2013 to 2020 was orbital rim advancement. Differences in practice between these time periods included an increase in patients with asymptomatic clinical presentation (27% versus 42%, P<0.001) and presentation with papilledema (1% versus 4%, P=0.003). Use of preoperative MRI significantly increased (1% versus 6%, P<0.001). Significant changes were noted in surgical technique and methods of fixation. By examining the American Board of Plastic Surgery tracer data, the authors can describe national trends in presentation, imaging, and surgical techniques for non -syndromic craniosynostosis repair over a 14-year period.