(13) The Cumulative Burden of Comorbidities on Outcomes After Mandibular Distraction Osteogenesis in Robin Sequence

Abstract:

Background: Mandibular distraction osteogenesis (MDO) is an effective treatment for obstructive sleep apnea (OSA) in patients with Robin Sequence (RS). However, the impact of additional comorbidities on MDO outcomes is poorly understood in patients with isolated RS. This study evaluates the burden of comorbid conditions on postoperative complications and readmissions following MDO.

Methods: A retrospective review was performed of patients with isolated RS who underwent MDO at a tertiary children’s hospital between 2004 and 2023, excluding those with less than six months of follow-up. Demographics and comorbidities were collected. Outcomes of interest included major complications and hospital readmissions. Statistical analyses included Chi-squared tests, Student’s t-tests, Mann Whitney-U tests, and multivariable logistic regression.

Results: A total of 86 patients met inclusion criteria. The median corrected gestational age at surgery was 42.7 weeks and median follow-up time was 6.4 years. OSA was present in 96.5% of patients. Concurrent respiratory comorbidities were present in 34.9% of patients, cardiac anomalies were present in 7.0%, gastrointestinal comorbidities were present in 3.5%, and hypotonia was present in 25.6%. Preoperative intubation was required in 19.8% of patients. Following MDO, 27.9% of patients experienced major complications, 12.8% of patients required readmission, and two patients (2.3%) experienced MDO failure, requiring tracheostomy. Multivariable logistic regression evaluating predictors of major complications post-MDO identified the presence of respiratory comorbidities (Odds Radio [OR]: 10.4, 95% Confidence Interval [CI]: 2.2 - 49.2, P = .003), cardiac comorbidities (OR: 31.4, 95% CI: 2.0 - 503.9, P = .015), and history of preoperative intubation (OR: 11.1, 95% CI: 2.3 - 53.0, P = .002) as independent risk factors. Regression analysis assessing predictors of readmission revealed hypotonia (OR: 9.8, 95% CI: 1.1 - 83.4, P = .037) and history of preoperative intubation (OR: 14.8, 95% CI: 1.9 - 117.8, P = .011) as independent risk factors. Each additional comorbidity was associated with a 2.6 times increased odds of major complications (P = .049) and a 5.1 times increased odds of readmission (P = .008).

Conclusion: MDO is a safe and effective treatment for airway obstruction in patients with isolated RS and concurrent respiratory, cardiac, and GI comorbidities, as well as hypotonia. However, our findings highlight the significant impact of a high comorbidity burden on postoperative complications and readmissions. Preoperative screening for concurrent anomalies and appropriate risk stratification are essential in preoperative management of patients who are deemed candidates for MDO, as is close postoperative follow-up for high-risk patients.
Postoperative Complications following MDO across Individual ComorbiditiesPostoperative Complications following MDO stratified by Number of Comorbidities