The Cumulative Burden of Comorbidities on Complications Following Mandibular Distraction Osteogenesis in Robin Sequence

<b>Objective:</b> Mandibular distraction osteogenesis (MDO) is an effective treatment for obstructive sleep apnea (OSA) in patients with Robin Sequence (RS). The impact of additional comorbidities on outcomes is poorly understood. This study evaluates the burden of comorbid conditions on postoperative complications following MDO. <b>Design:</b> Retrospective cohort study. <b>Setting:</b> Tertiary children's hospital. <b>Patients/participants:</b> Patients with RS who underwent MDO from 2004 to 2023, excluding those with diagnosed syndromes and under 6 months of follow-up. <b>Interventions:</b> No interventions were performed. <b>Main Outcome Measure(s):</b> Primary outcomes included major complications, readmissions, and reoperation. <b>Results:</b> Overall, 86 patients met the inclusion criteria. Median corrected gestational age at surgery was 42.7 weeks; median follow-up was 6.4 years. OSA was present in 100% of patients. Concurrent respiratory comorbidities were present in 34.9%, hypotonia in 25.6%, cardiac anomalies in 7.0%, and gastrointestinal comorbidities in 3.5%. Preoperative intubation was required in 19.8% of patients. Postoperatively, 27.9% experienced major complications, 12.8% required readmission, and 19.8% underwent reoperation. Two patients (2.3%) required tracheostomy placement. Multivariable logis6tic regression identified respiratory and cardiac comorbidities as independent predictors of major complications (<i>P</i> < .05). Preoperative intubation was a significant predictor of readmission (<i>P</i> < .05). Each additional comorbidity was associated with 2.7 times increased odds of major complications (<i>P</i> = .012) and 4.2 times increased odds of readmission (<i>P</i> = .008). <b>Conclusions:</b> These findings highlight the impact of comorbidity burden on complications, readmission, and reoperation in patients with RS following MDO. Preoperative screening, risk stratification, and patient counseling are essential in preoperative management, as is close postoperative follow-up for high-risk patients.