AAPS, American Association of Plastic Surgeons
AAPS, American Association of Plastic Surgeons
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2008 Annual Meeting Abstracts

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Reviewing 17 Years of Mandibular Distraction Osteogenesis with a New Stratified Surgical Complication Reporting System
Stephen M. Warren, MD, Pradip Shetye, DDS, Roberto Flores, MD, Barry H. Grayson, DDS, Joseph G. McCarthy, MD.
New York Universtiy Medical Center, New York, NY, USA.

Introduction: Any surgical procedure can have complications. Interestingly, reported complication rates for a given procedure can vary widely. For example, published mandibular distraction osteogenesis complication rates vary form 2.5 to 35 %. This disparity may be due to a technical difference or a difference in the definition of a complication. In order to correct these incongruities, we have developed a new stratified reporting system to capture the entire spectrum of perioperative events as well as to clarify the definition of a complication. To illustrate the power of this new reporting system, we stratified the perioperative events that occurred during the longest single-institution mandibular distraction osteogenesis experience.
Method: A review of all patients undergoing mandibular distraction osteogenesis between 1989 and 2006 was performed. All perioperative events were stratified into three categories: a minor incident did not result in an adverse outcome and could be resolved with non-invasive therapy (e.g. pain); a moderate incident could have resulted in an adverse outcome, but was resolved with invasive therapy (e.g. device dislodgment); a major incident (synonymous with a complication) resulted in an adverse outcome even with invasive therapy (e.g. fibrous union).
Result: 141 patients (mean age = 6.4 years, range 0.1 to 41.9 years).underwent mandibular distraction. 56 were treated with unilateral mandibular distraction and 85 underwent bilateral mandibular distraction (total = 56 + 85 + 85 = 226 procedures). An external distraction device was used in 185 procedures and a semiburied distraction device was used in 41 procedures. The native mandible was distracted in 190 procedures and grafted bone (iliac or rib) was distracted in 36 procedures. The following perioperative events were recorded: minor incidents occurred in 27.0% of patients, moderate incidents occurred in 20.3% of patients, and major incidents or complications occurred in 5.3% of patients. Perioperative incidents occurred significantly more frequently (p<0.05) in distracted bone grafts compared to distracted native mandible. Semiburied mandibular distraction had significantly more minor incidents (p<0.05) than external mandibular distraction, but significantly (p<0.05) fewer complications.
Conclusion: While a large range of complication rates have been reported with mandibular distraction, when stratified according to severity, complications occurred in only 5.3% of our patients. This novel reporting system can be adapted to stratify outcomes for a variety of surgical procedures.


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