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Impact of Hospital Characteristics on Mandibular Distraction Osteogenesis Outcomes Among Patients With Pierre Robin
Alexander P Marston1, Terral Patel2, Phayvanh P Pecha2
1Department of Otolaryngology-Head and Neck Surgery, Tufts University School of Medicine, Boston, MA, USA.
Insights
Patients with Pierre Robin sequence (PRS) undergoing mandibular distraction osteogenesis (MDO) at children's hospitals had fewer interventions and better discharge outcomes. This highlights the benefit of specialized pediatric care for PRS patients requiring MDO.
Area of Science:
- Pediatric surgery
- Craniofacial surgery
- Health services research
Background:
- Pierre Robin sequence (PRS) is a congenital condition requiring surgical intervention, often mandibular distraction osteogenesis (MDO).
- Outcomes for MDO in infants can vary based on hospital characteristics.
Purpose of the Study:
- To investigate the impact of hospital specialty and size on patient outcomes after MDO in infants with PRS.
- To compare outcomes between syndromic and nonsyndromic PRS patients.
Main Methods:
- Analysis of the Kids' Inpatient Database (2006, 2009, 2012) for infants (<12 months) with PRS undergoing MDO.
- Comparison of outcomes including length of stay, need for adjunct airway/nutritional interventions, and discharge disposition based on hospital type (children's vs. non-children's) and PRS diagnosis.
Main Results:
- Patients at children's hospitals had significantly fewer airway/nutritional interventions (12.8% vs. 24.4%) and nonroutine discharges (7.4% vs. 40.0%) compared to non-children's hospitals.
- Syndromic PRS patients had a higher incidence of gastrostomy tube placement (21.8% vs. 12.7%) than nonsyndromic PRS patients.
- Multivariable analysis confirmed children's hospitals were associated with less nonroutine discharge (OR = 0.07).
Conclusions:
- Children's hospitals are associated with improved outcomes for infants with PRS undergoing MDO.
- Patients treated at specialized pediatric centers demonstrate reduced need for interventions and higher rates of home discharge.
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.
