Sociodemographic Disparities in Surgical Timing and Outcomes of Mandibular Distraction Osteogenesis

Authors

Melanie Bakovic, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA.
Raina Patel, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA.
Asli Pekcan, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA.
Valeria Mejia, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA.
Laura Herrera-Gomez, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA.
Pasha Shakoori, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA.
Mark Urata, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA.
Jeffrey Hammoudeh, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA.

Document Type

Journal Article

Publication Date

9-22-2025

Journal

The Journal of craniofacial surgery

DOI

10.1097/SCS.0000000000011848

Keywords

Equitable care; head/neck; pediatric surgery; plastic surgery

Abstract

BACKGROUND: Mandibular distraction osteogenesis (MDO) is an effective procedure for alleviating upper airway obstruction in infants with micrognathia, yet the role of sociodemographic factors in MDO care and 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. This study assessed the Area Deprivation Index (ADI), median household income, unemployment rates, insurance status, race/ethnicity, and primary language. Outcome measures included age at surgery, length of hospital stay, readmission rates, and postoperative complications. RESULTS: A total of 133 patients underwent MDO. Patients in lower-income and higher-unemployment cohorts had greater rates of MDO failure and a higher incidence of operative site infections. White/Caucasian patients were the youngest at the time of surgery (3.6 wk) compared with Hispanic (4.5 wk), Asian (5.4 wk), and Black/African American patients (5.6 wk) (P=0.031). Black/African American patients had the highest readmission rate (75.0%, P=0.008) and the longest median hospital stay (120.0 days, P=0.007). No significant differences in outcome variables were observed between cohorts based on ADI, insurance status, or primary language. DISCUSSION: Patients from low socioeconomic neighborhoods experienced higher MDO failure rates and higher postoperative infection rates. Moreover, Black/African American patients underwent surgery later, had higher readmission rates, and faced longer hospital stays. Recognizing and addressing these disparities is crucial for providing equitable care.

APA Citation

Bakovic, Melanie; Patel, Raina; Pekcan, Asli; Mejia, Valeria; Herrera-Gomez, Laura; Shakoori, Pasha; Urata, Mark; and Hammoudeh, Jeffrey, "Sociodemographic Disparities in Surgical Timing and Outcomes of Mandibular Distraction Osteogenesis" (2025). GW Authored Works. Paper 7914.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/7914

Department

School of Medicine and Health Sciences Student Works