D111. Burden of Care of Delayed Extubation Following Mandibular Distraction Osteogenesis

Abstract

PURPOSE: Timing of extubation following mandibular distraction osteogenesis (MDO) varies by clinician and aims to minimize reintubation. This study aims to assess the effect of sleep apnea (OSA) severity and extubation timing on patient outcomes following MDO. METHODS: All patients that underwent MDO at an urban academic children’s hospital from 2004-2022 were retrospectively reviewed. Variables including diagnoses, pre-operative apnea hypopnea and central apnea indices(AHI, CAI), extubation outcomes and timing, and length of stay (LOS) were collected. Patients requiring reintubation were compared to those successfully extubated. RESULTS: One hundred two patients underwent MDO; on average, extubation occurred 10.7 days post-operatively. Twelve percent(n=12) were reintubated, of which one was syndromic(8%), and 3%(n=3) underwent tracheostomy. Reintubated patients had later extubations (14.1 vs. 10.2 days, p=.044), increased LOS (75.1 vs 37.0 days, p=.004), longer intensive care unit (ICU) LOS (69.0 vs 23.8 days, p=0.003), and a higher tracheostomy rate (27.3% vs 0%, p=0.001). No statistical difference in comorbidities, distance distracted, and pre-operative AHI or CAI existed between the two cohorts. CONCLUSION: The 12% reintubation rate in this cohort is comparable to the literature. Reintubation is associated with later extubation independent of OSA severity, doubled LOS, tripled ICU LOS, and 27% higher tracheostomy rates. Extensive analysis did not pinpoint factors contributing to reintubation outside of timing. Timing of extubation is a multifactorial decision; further studies are needed to further decrease the burden of care and improve outcomes.