Impact of Hospital Characteristics on Mandibular Distraction Osteogenesis Outcomes Among Patients With Pierre Robin Sequence Utilizing a National Inpatient Database

Abstract

Objectives: This study collected national inpatient data to investigate the impact of hospital specialty and size on patient outcomes following mandibular distraction osteogenesis (MDO). Design: Kids’ Inpatient Database was used to identify patients less than 12 months of age with Pierre Robin sequence (PRS) who underwent MDO in one of the following years: 2006, 2009, and 2012. Setting: Inpatient database from the United States. Participants: Two hundred seventy-six patients with PRS underwent MDO with 134 (48.6%) identified as nonsyndromic and 142 (51.4%) as syndromic. Interventions: Mandibular distraction osteogenesis. Main Outcome Measures: Length of hospital stay, adjunct airway and nutritional interventions and disposition. Results: The average length of stay was 24 and 30 days for patients with nonsyndromic and syndromic PRS, respectively ( P = .066). Patients with a syndromic as compared to nonsyndromic diagnosis had a higher incidence of gastrostomy tube placement (21.8 vs 12.7%, P = .045). Univariate analysis showed that a lower proportion of patients at children’s hospitals as compared to non-children’s hospitals necessitated 1 or more airway or nutrition-related intervention (19/148 [12.8%] vs 31/127 [24.4%]; P = .012) and had a lower incidence of a nonroutine discharge (transfer or patient death; 7.4% vs 40.0% nonroutine; P < .001). Multivariable analysis additionally revealed that patients at children’s hospitals were less likely to discharge nonroutine (OR = 0.07, 95% CI: 0.02-0.32). Conclusions: Results from this national cohort demonstrated that at children-specific hospitals patients with PRS were less likely to require additional airway and nutritional procedures and more likely to discharge to home.

Survival, hospitalisation and surgery in children born with Pierre Robin sequence: a European population-based cohort study

“…This population-based cohort study reported on survival and hospitalisations of 463 children born with PRS in nine European countries, which is in contrast to many of the published studies on PRS limited to case series 19. We were not able to analyse data separately for children with isolated PRS and those with associated anomalies.…”

“…This population-based cohort study reported on survival and hospitalisations of 463 children born with PRS in nine European countries, which is in contrast to many of the published studies on PRS limited to case series. 19 We were not able to analyse data separately for children with isolated PRS and those with associated anomalies. However, an estimated 72% of children were likely to have had isolated PRS, as observed in a recent EUROCAT study on the epidemiology of PRS which included most of the children in this study.…”