SP24. Understanding the Role of Sociodemographic Factors in Mandibular Distraction Osteogenesis Care

PURPOSE: Mandibular distraction osteogenesis (MDO) is an effective procedure for alleviating upper airway obstruction in infants with micrognathia, offering a conservative approach compared to tracheostomy. While previous studies have examined complications and factors influencing hospital stay and readmission rates, the role of sociodemographic factors in MDO outcomes remains underexplored. This study aims to uncover potential disparities in patient care related to MDO. METHODS: This retrospective review analyzed patients who underwent MDO at a tertiary children’s hospital between 2004 and 2023, excluding those with less than six months of follow-up. This study assessed the Area Deprivation Index (ADI), a decile score based on zip codes where a higher score reflects higher socioeconomic disadvantage from factors such as education, employment, and housing. Additional variables, including race/ethnicity, insurance status, and primary language, were also examined. The primary outcomes measured were age at surgery, length of hospital stay, readmission rates, and postoperative complications. Statistical analyses were conducted using Pearson’s chi-squared tests and Student’s t-tests. RESULTS: Of the 133 patients who underwent MDO, 39.1% were Hispanic and 61.1% were covered by public insurance. One third of the patients were in the highest ADI quartile. The median age at surgery, corrected for gestational age, was 4.9 weeks (IQR 3.0 to 14.3 weeks), and the median hospital stay was 46.0 days (IQR 31.5 to 63.5 days). Overall, 11.3% of patients required readmission, and 27.1% experienced major complications requiring hospitalization. Patients in the highest quartile of ADI were older at the time of surgery (6.9 vs. 4.4 weeks, p=0.041) and had a higher incidence of operative site infections (24.3% vs. 10.4%, p=0.04). White patients had the youngest age at surgery (3.6 weeks) compared to Hispanic (4.5 weeks), Asian (5.4 weeks), Black/African American (5.6 weeks), and Other/Unspecified groups (9.4 weeks) (p=0.031). Black/African American patients had the highest readmission rate (75.0%, p < 0.001) and the longest median hospital stay (120.0 days, p = 0.007), along with lower post-intervention weights at 6 and 12 months (6.6 kg, p = 0.02; 7.3 kg, p = 0.015). No significant differences in outcome variables were observed between cohorts based on insurance status or primary language. CONCLUSION: There are significant sociodemographic disparities in MDO outcomes, revealing that patients from socioeconomically deprived neighborhoods experience delayed surgeries and higher postoperative infection rates. Moreover, Black/African American patients were found to undergo surgery later, have higher readmission rates, and face longer hospital stays. Recognizing and addressing these disparities is crucial for providing equitable care in MDO.