Orthognathic Surgeries and Facial Bone Repairs in those with Craniosynostosis

Abstract Purpose: The objective of the present study was to examine the association between infectious complications, length of stay (LOS) and obstructive sleep apnea (OSA) in patients with craniosynostosis undergoing orthognathic surgery and facial bone repairs. Materials and Methods: The Nationwide Inpatient Sample for the years 2006-2014 was used and patient cohort was selected using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes for craniosynostosis. All patients with craniosynostosis undergoing orthognathic surgeries and/or facial bone repairs were selected for analysis. Independent variables included all patient and hospital level factors such as age, comorbid conditions, presence of sleep apnea, region and teaching status. The outcomes of interest included development of infectious complications, LOS and presence of OSA. Results: During the study period, 3420 patients with craniosynostosis were hospitalized for orthognathic surgery and/or facial bone repairs. The average age at admission was 10.5 years and the mean LOS was 14.3 days. Routine discharge occurred in 89.2% of patients and the majority of patients had elective admission (72%). Most patients were White (66.8%) with private insurance (58.5%) and underwent surgery in an urban teaching hospital (87.4%). The most common diagnosis and procedure were mandibular hypoplasia (59.6%) and mandibular osteoplasty (44.5%), respectively. Factors found to be significantly associated with increased LOS included presence of OSA, bacterial infection, viral infection, pneumonia, comorbid burden and type of procedure whereas increased age and elective admission were associated with decreased LOS (p<.05). Factors found to be significantly associated with the development of infectious complications included race, comorbid burden and teaching status whereas increased age and elective admission were protective against developing infectious complications (p<.05). Factors that were associated with OSA included age, admission status and comorbid burden (p<.05). Conclusions: Results of this study will inform hospitals and providers that treat patients with craniosynostosis as to the patient and hospital level factors that are associated with LOS, development of infectious complications and OSA. The ability to identify high risk patients may reduce the likelihood of complications, improve quality of care, and reduce the burden on the healthcare system.