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A Standardized Care Pathway following Mandibular Distraction in Infants Less Than 3 Months of Age
Grace R Leu1, Andrew R Scott1,2,3
1Tufts University School of Medicine, Boston, Massachusetts, USA.
Insights
Standardizing postoperative care for infants undergoing mandibular distraction osteogenesis (MDO) led to shorter hospital stays and more consistent treatment. This protocol improved outcomes compared to individualized care plans.
Area of Science:
- Pediatric surgery
- Critical care medicine
- Anesthesiology
Background:
- Mandibular distraction osteogenesis (MDO) is a surgical procedure for craniofacial abnormalities.
- Postoperative care following MDO in infants can be complex and variable.
- Lack of standardized protocols may lead to inconsistent outcomes.
Purpose of the Study:
- To evaluate the impact of a standardized postoperative care protocol for infants undergoing MDO.
- To compare length of stay, mechanical ventilation duration, and sedative medication use before and after protocol implementation.
Main Methods:
- Retrospective chart review of infants (<90 days old) who underwent MDO.
- Comparison of two groups: pre-protocol (physician discretion) and post-protocol (standardized care).
- Analysis of postoperative length of stay, mechanical ventilation, and sedative use.
Main Results:
- The standardized protocol group showed a trend towards shorter mean postoperative length of stay (13.3 days less).
- Protocol patients received significantly fewer midazolam boluses (P < .01).
- The protocol resulted in more consistent postoperative length of stay, ventilation duration, and sedative exposure (P < .01).
Conclusions:
- Standardizing airway and sedation practices in infants undergoing MDO can lead to a more predictable postoperative course.
- A protocol-driven approach may be superior to case-by-case management for MDO postoperative care.
- Implementation of standardized protocols can optimize resource utilization and patient outcomes.
Objectives:
To assess for differences in postoperative care following mandibular distraction osteogenesis (MDO) in infants before and after implementation of a standardized protocol.
Study Design:
Retrospective chart review.
Setting:
Urban tertiary pediatric hospital.
Subjects And Methods:
The inpatient charts of infants who underwent MDO before 90 days of age were assessed for metrics such as postoperative length of stay (LOS), duration of mechanical ventilation, and the choice and duration of sedating medications.
Results:
Over a 6-year period, 16 patients met inclusion criteria. The first 4 consecutive patients were managed at the discretion of the critical care staff. The remaining 12 infants were managed with a planned 4- to 6-day period of postoperative intubation, during which a standard protocol determined the choice, dosage, and duration of sedating medications. The mean age was similar between groups (preprotocol: mean, 26.5 days; protocol: mean, 20.3 days; P = .51). The mean postoperative LOS was 13.3 days less among infants managed with the protocol (P = .06), and the mean number of midazolam boluses was fewer among protocol patients (P < .01). A more consistent postoperative LOS, duration of mechanical ventilation, and exposure to sedating medications was observed among protocol subjects (P < .01). The LOS for 2 patients in the preprotocol group was extended due to iatrogenic withdrawal syndrome. There were no instances of accidental extubation or anoxia in either group.
Conclusions:
Among infants undergoing MDO, standardizing postoperative airway and sedation practices may offer a more predictable postoperative course as compared with a case-by-case management philosophy.
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