What Factors Affect Safe Bedside Extubation After Mandibular Distraction?

Objective There is no universal protocol for extubation following mandibular distraction osteogenesis (MDO) surgery in infants with Robin sequence (RS). The aims of this study were to identify the frequency and contributing factors for reintubation after MDO, to help determine the optimal setting for planned extubation. Design This is a retrospective observational study of patients with RS managed with MDO during their first year of life from 2013 to 2021. Main Outcome Measures The primary outcome variable was the need for reintubation <24 h after extubation. A secondary outcome was the frequency of oxygen saturation <95% after extubation. Results Fifty-two subjects were included. Of these, 31 (59.6%) were male, 43 (82.7%) had a cleft palate, 19 (36.5%) were syndromic, and 24 (46.2%) had ≥1 comorbidity. Extubation was at 3.6 ± 2.4 days after surgery and 1 patient (1.9%) required reintubation. Forty-one (78.8%) had ≥1 transient oxygen desaturation managed with supplemental oxygen ( n = 25, 61%) or continuous positive airway pressure ( n = 16, 39%). Increased risk for postextubation respiratory events was associated with Stickler syndrome ( P = .01), musculoskeletal, neurologic, or endocrine comorbidities ( P < .001), low birthweight ( P = .044), and high preoperative obstructive Apnea-Hypopnea Index ( P = .037). Conclusions and Relevance Reintubation was rare and minor postextubation oxygen desaturations, while common, were readily treated utilizing standard intensive care unit protocols. We conclude that most infants with RS can be safely extubated in their care unit following MDO. This minimizes medical resources, decreases hospital charges, and simplifies patient management compared to returning to the operating room for extubation.