Diagnosis of 22q11.2 Deletion Syndrome is not Independently Associated with Complications Following Speech Surgery: A National Surgical Quality Improvement Program Pediatric Study

Abstract

Objective

Children with 22q11.2 deletion syndrome (22qDS) often experience velopharyngeal insufficiency. We aimed to understand outcomes following speech surgeries in children with 22qDS compared to those without.

Design, Patients, and Outcomes

The National Surgical Quality Improvement Program (NSQIP)-Pediatric database from 2013 to 2020 identified patients ≥3 years old who underwent speech surgery. Outcomes included postoperative length of stay (LOS) >2 days and 30-day complications. Descriptive statistics and multivariable logistic regression were performed.

Results

Among 3227 patients who underwent speech surgery, 273 (8.5%) had 22qDS. They were more often premature (14.7% vs 10.1%, p =.03) with worse American Society of Anesthesiologists (ASA) classification (class I: 3.3%; class II 48.3%; class III + 48.3% compared to those without 22qDS (24.0%, 62.7%, and 13.3%, respectively) (p < .0001)), with more airway abnormalities (26.7% vs 14.2%, p < .0001), and more cardiac risk factors (56.4% vs 8.5%, p < .0001). On regression analysis, 22qDS diagnosis conferred higher odds of prolonged postoperative LOS (adjusted odds ratio [aOR]: 2.02, 95% confidence interval [CI]: 1.43-2.86). Complications were associated with chronic lung disease (aOR 4.01, 95% CI: 1.46-11.06), surgeon specialty (pediatric otolaryngology vs plastics aOR0.74, 95% CI: 0.46-1.19; other specialty vs plastics aOR 0.43, 95% CI: 0.22-0.85), and ASA classification (class II vs class I aOR 1.11, 95% CI: 0.62-2.01; class III + vs class I aOR 2.30, 95% CI: 1.18-4.50); however, diagnosis of 22qDS was not associated with complications.

Conclusions

Children with 22qDS undergoing speech surgery have prolonged postoperative LOS without higher odds of complications. Investigation of contributing factors including protocolization of this patient population is warranted.

Keywords

DiGeorge syndrome velocardiofacial syndrome sphincter pharyngoplasty posterior pharyngeal flap velopharyngeal dysfunction

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