Adverse Events Following Palatoplasty in Patients With Robin Sequence: The Impact of Prior Airway Treatment

Objective To examine the impact of prior upper airway obstruction (UAO) management on postoperative complications following palatoplasty in patients with Robin Sequence (RS) and compare the costs of pediatric intensive care unit (PICU) versus surgical floor care. Design Prospective cohort study. Setting Tertiary pediatric hospital. Patients/Participants Fifty-eight patients with RS undergoing palatoplasty from 2006 to 2020. Interventions Patients were grouped by prior UAO management: conservative, tongue-lip adhesion (TLA), or mandibular distraction osteogenesis (MDO), before undergoing palatoplasty. Main Outcome Measures Primary outcomes are airway and non-airway related complications after palatoplasty based on prior UAO management: conservative (n = 30), TLA (n = 14), or MDO (n = 14). Secondary outcomes included severity of complications and a cost comparison of PICU versus floor care. Results The median age at palatoplasty was 12.9 months [interquartile range: 10.8-15.6]. Airway complications occurred in 31% of patients: conservative (20.0%), TLA (35.7%), and MDO (50.0%) ( P = .129). Non-airway complications were observed in 22.4% of patients: conservative (26.7%), TLA (7.1%), and MDO (28.6%) ( P = .320). Most complications were minor in severity. Pediatric intensive care unit admission rates were significantly higher for TLA and MDO groups (85.7% each) compared to conservative (33.3%; P < .001). Pediatric intensive care unit care was associated with a 72.1% increase in total costs compared to floor care. Conclusion Airway and non-airway complications are common following palatoplasty in RS patients. Appropriate UAO management during infancy results in equally safe post-palatoplasty airway and non-airway complications. Since most complications are minor, admitting medically stable patients to the surgical floor rather than the PICU may reduce costs and conserve resources without compromising care.