Benefits of the enhanced recovery after surgery pathway for orthognathic surgery

Stratton, Michael Slade; Waite, Peter D.; Powell, Kathlyn; Scopel, Michaella; Kukreja, Promil

doi:10.1016/j.ijom.2021.04.008

Cited by 21 publications

(12 citation statements)

References 22 publications

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“…Further, the ERAS group reported a significantly lower incidence of PONV (1.2 episodes of PONV) compared to the control group (2.4 episodes of PONV). 21 ERAS protocols can significantly reduce length of hospitalization and post-operative pain, both of which proved to be significant risk factors for readmission in this study. Patients with an initial diagnosis of mandibular hypoplasia were less likely to be readmitted.…”

Section: Discussionmentioning

confidence: 55%

“…19 Enhanced Recovery After Surgery Protocols (ERAS) have been recently developed and tested for orthognathic surgery. 20,21 Ferrara et al evaluated the efficacy for an ERAS protocol consisting of specific surgical and anesthetic regimens for each stage of care (ie, intraoperative) particularly in terms of same-day discharge (within 24 hours). The study sample consisted of patients who underwent maxillary and mandibular osteotomy (MMO) with or without genioplasty.…”

Section: Discussionmentioning

confidence: 99%

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Orthognathic Surgery in the US. What are the Risk Factors for Readmission?

Stanbouly,

Selvi,

Chuang

et al. 2024

FACE

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Purpose: Contemporary orthognathic surgery is safe and predicable. However, there are opportunities for further improvement. The purpose of this study was to estimate the frequency and identify risk factors for readmission following orthognathic surgery in the US. Materials and methods: A retrospective cohort study was conducted using the Nationwide Readmissions Database (NRD) on patients who underwent orthognathic surgery in 2017 and 2018. There were multiple heterogenous predictor variables that were broadly comprised of patient characteristics and hospitalization characteristics. The primary outcome variable was readmission. Logistic regression analysis was used to determine risk factors for hospital readmission. A P-value less than .05 was considered statistically significant. Results: The final study sample consisted of 8578 patients (mean age, 27.2 years), of whom 74 patients (0.9%) readmitted. Relative to a length of stay (LOS) of 0 to 2 days, a LOS of >2 days (OR 1.90, P < .05) was a risk factor for readmission. Patients with acute post procedural pain were 3 times more likely to readmit ( P < .05). Conclusion: Patients with an LOS of >2 days were at risk for readmission relative to patients with an LOS of 0 to 2 days. Post-procedural pain was also a significant risk factor for readmission. Finally, patients with mandibular hypoplasia were less likely to readmit.

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Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Orthognathic Surgery in the US. What are the Risk Factors for Readmission?

Stanbouly,

Selvi,

Chuang

et al. 2024

FACE

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“…After implementation of the ERAS protocol, their patients received less opioids and had a lower incidence of PONV. 39 While ERAS protocols have been shown to be effective for orthognathic surgery they have yet to be implemented and formally adopted by the ERAS society. 39,40 Eight-five percent of study participants discharge their bimaxillary osteotomy patients postoperative day 1.…”

Section: Discussionmentioning

confidence: 99%

“…39 While ERAS protocols have been shown to be effective for orthognathic surgery they have yet to be implemented and formally adopted by the ERAS society. 39,40 Eight-five percent of study participants discharge their bimaxillary osteotomy patients postoperative day 1. Bowe et al and Huamán et al independently reported hospital length of stay in large respective samples where the average length of stay was 1.2 days and 1.3 days respectively.…”

Section: Discussionmentioning

confidence: 99%

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Current Orthognathic Surgery Practice Patterns Among Academic OMS

Bourne

Kinard

2023

The Cleft Palate Craniofacial Journal

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Objective Currently there is variation in perioperative care of orthognathic surgery patients and limited clinical practice guidelines. The current orthognathic surgery practice patterns among US academic OMFS training centers have not been described. The purpose of this study is to describe the practice patterns among US academic OMFS training centers. Design The study design is cross-sectional. Data was collected through a survey of the sample. Setting OMFS programs in the US. Participants Academic OMFS. 573 surgeons were contacted and 85 responses were received. Main Outcome Measure Descriptive and bivariate statistics were reported. Results Respondents were 87% male and worked in full-time academic (80%), part-time academic (19%), or military settings (1%). Thirty-one percent have practiced for 30 years or more and then 29% with 11–20 years, 18% with 21–30 years, 12% with 6–10 years and 11% with 1–5 years. Twenty-six percent of respondents perform 20–40 orthognathic surgeries a year, 22% perform less than 20 surgeries a year, 21% perform 40–60 surgeries per year, and 19% perform more than 100 surgeries per year. Intraoperatively, 48% of surgeons request a mean arterial pressure of 60–64 mmHg, 25% utilize tranexamic acid (TXA), 85% report a blood loss of less than 400 milliliters, and 93% report a blood transfusion rate of <1%. Conclusion There are variations in orthognathic surgery practice patterns with limited clinical practice guidelines. Only 13 of the 32 survey questions had a single response holding a simple majority. This study demonstrates the need for further research and evidence-based protocols and decision making.

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Outpatient orthognathic surgery: a prospective study of predictive factors for the length of hospital stays

Prevost,

Lauwers,

Varazzani

et al. 2023

Clin Oral Invest

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ObjectivesTransitioning from non-outpatient orthognathic surgery to outpatient surgery is a new challenge, and it is essential to target the eligible population as precisely as possible. Several authors describe series of outpatient orthognathic surgery but do not include the reasons for their success or failure.The main aim of this study was to identify the factors signi cantly associated with "successful" outpatient orthognathic treatment.The secondary objective was to determine the factors signi cantly associated with prolonged hospital stays (≥ 2 nights). Materials & Methods:A prospective cohort study including patients undergoing orthognathic surgery was conducted over a period of 1 year. We recorded the prognostic factors that contributed to successful outpatient treatment and prolonged hospital stays. These factors were evaluated by bivariate and multivariate analysis. Results:102 patients were included and the success rate of treatment was 65%. The variables that were isolated by multivariate analysis were: patients over the age of 22, procedures ending before 1 pm, brief operations, the absence of both postoperative vomiting and the administration of morphine. Conclusion:Patient selection, organisation of outpatient facilities and anaesthetic protocols contribute to the development of outpatient orthognathic surgery. These initial considerations provide a framework for our practice, but the considerations that predict the failure of outpatient surgery will need to be clari ed. Clinical Relevance:Orthognathic surgery can be performed on outpatient basis in selected cases. Age, the operative time, procedure end time, postoperative vomiting and the administration of morphine are associated with the success of outpatient care.

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Benefits of the enhanced recovery after surgery pathway for orthognathic surgery

Cited by 21 publications

References 22 publications

Orthognathic Surgery in the US. What are the Risk Factors for Readmission?

Orthognathic Surgery in the US. What are the Risk Factors for Readmission?

Current Orthognathic Surgery Practice Patterns Among Academic OMS

Outpatient orthognathic surgery: a prospective study of predictive factors for the length of hospital stays

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