Which Factors Affect Length of Stay and Readmission Rate in Mandibular Distraction Osteogenesis?

Self Cite

Objective: The purpose of this study was to determine whether performing mandibular distraction osteogenesis (MDO) during the neonatal period increased inpatient complications as measured through health-care burden. Materials and Methods: This was a retrospective cohort study of the Kids’ Inpatient Database from 2000 to 2011. Infants receiving MDO prior to 12 months of age were included. The primary study predictor was distraction age, classified as either neonatal or non-neonatal. Secondary predictors were patient demographics, hospitalization characteristics, diagnoses, and procedures. The outcomes were the number of procedures performed, postoperative length of stay (pLOS), hospital charges, and the discharge transfer rate. Outcomes were compared between the primary predictors using χ2 and independent 2-sample t tests. Multiple linear and logistic regression models were created using clinically relevant predictors to assess the independent effect of neonatal age on each outcome. Results: The study sample contained 102 patients, of who 50 (49.0%) were distracted in the neonatal period. Neonatal MDO patients were more likely to have a cleft palate (86.0% vs 55.8%; P < .001) and present with feeding difficulties (38.0% vs 19.2%; P = .036) that were treated through total parenteral nutrition (26.0% vs 9.6%; P = .030) but otherwise did not have significantly different characteristics compared to non-neonatal patients. The multiple regression models confirmed that neonatal age did not influence any of the study outcomes, although other secondary predictors were found to influence the pLOS, hospital charges, and number of inpatient procedures. Conclusions: Neonatal MDO was not associated with increased complications. At experienced centers, neonatal status should not be considered a contraindication to treatment.

Section: Introductionmentioning

confidence: 99%

Neonatal Mandibular Distraction Does Not Increase Inpatient Complications

Lee

Eisig

Chuang

et al. 2019

Self Cite

“…Readmissions to the hospital following MDO were most commonly due to respiratory issues or surgical site infections. Interestingly, Lee et al found that preoperative feeding status and the presence of multiple congenital anomalies did not appear to influence readmission rates (Lee et al, 2019). Rather, the airway support prior to MDO, whether invasive or otherwise, was the greatest predictor.…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review of Mandibular Distraction Osteogenesis Versus Orthodontic Airway Plate for Airway Obstruction Treatment in Pierre Robin Sequence

Abbas

Lavin

Fahy

et al. 2021

Objective: Mandibular distraction osteogenesis (MDO) is frequently performed to address airway obstruction in patients with Pierre Robin sequence (PRS), though more recently the technique of orthodontic airway plating (OAP) has gained traction. We aimed to evaluate OAP compared to MDO for airway obstruction in PRS. Design: A systematic literature search across PubMed, Embase, and Google Scholar identified all studies published in English, which involved MDO or any form of OAP as treatments for PRS. All relevant articles were reviewed in detail and reported on, adhering to PRISMA guidelines. Main Outcome Measures: Airway (tracheostomy avoidance, decannulation rate), feeding (full oral feeding tolerance). Results: Literature search identified 970 articles, of which 42 MDO studies and 9 OAP studies met criteria for review. A total of 1159 individuals were treated with MDO, and 322 individuals were treated with OAP. Primary outcomes appear similar for MDO and OAP at face value; however, this must be interpreted with different pretreatment contexts in mind. Conclusions: Orthodontic airway plating may be considered for airway obstruction in PRS, as some airway-related and feeding-related outcomes appear similar with MDO, per existing evidence in the literature. However, since PRS severity differed between studies, OAP cannot be uniformly considered a replacement for MDO. Further research is required to more comprehensively assess these treatment modalities inclusive of metrics that allow for direct comparison.

“…In their extensive experience of 123 patients, Lam et al, found airway complexity, as demonstrated by the need for multiple airway procedures, to predict complications on multivariate analysis. Lee et al, similarly correlated airway intervention prior to MDO with a higher rate of readmission and described a trend towards increase hospital length of stay in such patients (Lee et al, 2019). Gastrostomy tube dependence, concurrent airway abnormalities, and preoperative intubation have all been associated with treatment failure after MDO (Flores et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

“…While the efficacy of MDO in avoiding tracheostomy and improving feeding difficulties in patients with PRS has been well described (Lidsky et al, 2008; Lam et al, 2014; Khansa et al, 2017; Zhang et al, 2018), the procedure has been associated with various complications (Master et al, 2010; Khansa et al, 2017; Zhang et al, 2018; Lee et al, 2019). Though often minor, adverse events have been reported in as many as 40% of patients undergoing MDO (Zhang et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Early Adverse Events Following Pediatric Mandibular Advancement: Analysis of the ACS NSQIP-Pediatric Database

Carlson

Bharadwaj

Dougherty

et al. 2021

Objective This study aims to assess early adverse events and patient factors associated with complications following mandible distraction osteogenesis (MDO). Materials and Methods The American College of Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-Pediatric) database, years 2012 to 2019, was queried for patients undergoing mandible advancement via relevant Current Procedural Terminology and postoperative diagnosis codes. Thirty-day adverse events and co-morbidities are assessed. Results A total of 208 patients were identified with 17.3% (n = 36) experiencing an adverse event, reoperation (n = 14), and readmission (n = 11) being most common. Patients < 365 days old at the time of operation were more likely to experience an adverse event (26.1% vs 10.8%; P = .005). However, among patients less than 1 year of age, differences in the complication rates between patients ≤ 28 days and >28 days (30.2% vs 22.2%; P = .47) and those weighing ≤ 4 kg and >4 kg (31.7% vs 11.5%; P = .063) did not reach statistical significance. Conclusions Adverse events following mandible advancement are relatively common, though often minor. In our analysis of the NSQIP-Pediatric database, neonatal age ( ≤ 28 days) or weight ≤ 4 kg did not result in a statistically significant increase in complications among patients less than 1 year of age. Providers should consider early intervention in patients who may benefit from MDO.