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

Purpose: Because Robin sequence (RS) is clinically heterogeneous, there is uncertainty as to whether different presentations yield different perioperative outcomes. The purpose of this study was to evaluate factors associated with postoperative length of stay and readmission rate after mandibular distraction osteogenesis (MDO) for RS.

Materials and methods: This was a 10-year retrospective cohort of patients with RS who had MDO performed from 2007 through 2017 at the Morgan Stanley Children's Hospital of the NewYork-Presbyterian/Columbia University Irving Medical Center (New York, NY). Predictor variables were the presence of multiple anomalies, airway intervention used before MDO, and feeding method used before MDO. Outcome variables were postoperative day (POD) of discharge and number of readmissions from the period of discharge to hardware removal. Patient characteristics and outcomes were compared within predictors using Fisher's exact and 2-tailed Student's t tests. Multiple regression models were calculated for each outcome variable using univariate predictors with P values less than or equal to .25.

Results: Twenty-four patients who had MDO performed at a mean age of 18.1 weeks were included in this study. On average, patients were extubated on POD 6.6 and distracted to 13.9 mm. Seven patients (29.2%) were readmitted from the period of discharge to hardware removal. Patients receiving an invasive airway intervention before MDO were significantly older at the time of the operation (55.0 vs 8.4 weeks; P = .01). In addition, these patients had a significantly higher readmission rate (80.0 vs 15.8%; P = .01) with a trend toward longer postoperative stays (45.0 vs 21.6 days; P = .06). Feeding status and presence of multiple anomalies did not appear to influence these outcomes.

Conclusions: Baseline airway intervention may be useful for predicting length of stay and readmission rate after MDO.