Sociodemographic Disparities in Surgical Timing and Outcomes of Mandibular Distraction Osteogenesis

Mandibular distraction osteogenesis (MDO) is an effective procedure for alleviating upper airway obstruction in infants with micrognathia, yet the role of sociodemographic factors in MDO care and outcomes remains underexplored. This study aims to uncover potential disparities in patient care related to MDO.

This retrospective review analyzed patients who underwent MDO at a tertiary children's hospital between 2004 and 2023. This study assessed the Area Deprivation Index (ADI), median household income, unemployment rates, insurance status, race/ethnicity, and primary language. Outcome measures included age at surgery, length of hospital stay, readmission rates, and postoperative complications.

A total of 133 patients underwent MDO. Patients in lower-income and higher-unemployment cohorts had greater rates of MDO failure and a higher incidence of operative site infections. White/Caucasian patients were the youngest at the time of surgery (3.6 wk) compared with Hispanic (4.5 wk), Asian (5.4 wk), and Black/African American patients (5.6 wk) (P=0.031). Black/African American patients had the highest readmission rate (75.0%, P=0.008) and the longest median hospital stay (120.0 days, P=0.007). No significant differences in outcome variables were observed between cohorts based on ADI, insurance status, or primary language.

Patients from low socioeconomic neighborhoods experienced higher MDO failure rates and higher postoperative infection rates. Moreover, Black/African American patients underwent surgery later, had higher readmission rates, and faced longer hospital stays. Recognizing and addressing these disparities is crucial for providing equitable care.