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Pediatric Orthognathic Surgery: National Analysis of Perioperative Complications
Christopher L Kalmar1, Anna R Carlson1, Vijay A Patel2
1Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia.
Insights
Pediatric orthognathic surgery is generally safe, but younger children under 6 years old face higher risks of complications. Specific comorbidities and earlier surgical timing, especially for bilateral sagittal split osteotomies, increase adverse events in children.
Area of Science:
- Pediatric surgery
- Craniofacial surgery
- Surgical quality improvement
Background:
- Orthognathic surgery traditionally occurs after skeletal maturity.
- Pediatric orthognathic surgery is increasing, but risks in this population are not well-defined.
Purpose of the Study:
- To analyze adverse events in pediatric orthognathic surgery.
- To identify risk factors associated with complications in children.
Main Methods:
- Utilized the American College of Surgeons National Surgical Quality Improvement Program Pediatric dataset.
- Analyzed complications, readmissions, and reoperations for pediatric orthognathic procedures in 2018.
Main Results:
- Overall adverse event rate was 7.8%, linked to comorbidities like respiratory issues, developmental delay, and neuromuscular disorders.
- Children under 6 years old had significantly higher adverse events, including surgical site infections and pneumonia.
- Bilateral sagittal split osteotomies before age 13.5 were associated with a 7.1-fold increased risk of adverse events.
Conclusions:
- Pediatric orthognathic surgery demonstrates a relatively low adverse event rate.
- Younger children, particularly those under 6 years old, experience significantly increased risks.
- Comorbidities and early surgical intervention are key risk factors in pediatric patients.
Background:
Orthognathic surgery has traditionally been performed after skeletal maturity. Although these procedures are also being performed in children, the implications of earlier intervention and specific risk factors in this younger population remain unknown.
Methods:
The American College of Surgeons National Surgical Quality Improvement Program Pediatric dataset was queried for orthognathic procedures performed in 2018. Complications, readmissions, and reoperations were analyzed with appropriate statistics.
Results:
Overall adverse event rate after orthognathic surgery in pediatric patients was 7.8% (n = 22 of 281), which were associated with having any comorbidity (P < 0.001), overall respiratory comorbidities (P = 0.004), structural pulmonary abnormality (P < 0.001), developmental delay (P = 0.035), structural central nervous system abnormality (P < 0.001), and neuromuscular disorder (P = 0.035). Most common complications were excessive bleeding (2.5%), surgical site infection (1.1%), and pneumonia (0.7%). Orthognathic surgery in children below 6 years of age is associated with significantly increased adverse events (P < 0.001), including surgical site infection (P < 0.001), pneumonia (P = 0.022), readmission (P < 0.001), and reoperation (P < 0.001). Le Fort I osteotomies (P < 0.001) and bilateral sagittal split osteotomies (P = 0.009) took significantly longer for older patients in the years of permanent dentition than younger patients in the years of deciduous dentition. Single- and double-jaw procedures in pediatric patients have similarly low adverse events (P all ≥0.130). Interestingly, bilateral sagittal split osteotomies performed before 13.5 years of age were associated with a higher risk of adverse events (P = 0.012), such that these younger patients were 7.1 times more likely to experience adverse events if their procedure was performed earlier.
Conclusions:
Orthognathic surgery is relatively safe, but children in the years of deciduous dentition under 6 years of age have significantly increased risk of adverse events.
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