Does Practice Type Determine the Complexity of Patients Encountered for Orthognathic Surgery?

Comparison of Orthognathic Surgery Outcomes Between Patients With and Without Underlying High-Risk Conditions: A Multidisciplinary Team-Based Approach and Practical Guidelines

“…The anesthetic surgical literature reports outcome studies conducted on patients with underlying conditions who underwent surgery and were managed using a structured and multidisciplinary approach [25,26,27]; however, these studies have not formally described OGS procedures. Some studies on OGS have included the average ASA-PS or Charlson comorbidity scores but have not reported the type of underlying conditions, whereas other OGS studies describing the diagnosis of underlying conditions have primarily included patients with conditions (smoking, hypertension, and diabetes) that are commonly observed in all surgical contexts [4,5,29,30,31,32].…”

“…Studies that have examined outcomes across various types of surgical procedures have demonstrated that patients with a high comorbidity burden are more prone to postoperative complications, such as wound healing problems, infections, and organ- or system-related problems (i.e., problems in the vascular, urinary, digestive, and nervous systems) than those without comorbidities [25,26,27,28]. From the existing OGS-related data, patients with relatively high ASA-PS and Charlson scores or a high comorbidity burden have also been determined to be prone to complications, an extended length of hospital stay, and high medical costs [4,5,29,30,31,32]. However, differences in study design and data collection impair a reliable head-to-head comparison between our results and those of the mentioned previous studies [4,5,29,30,31,32].…”

“…From the existing OGS-related data, patients with relatively high ASA-PS and Charlson scores or a high comorbidity burden have also been determined to be prone to complications, an extended length of hospital stay, and high medical costs [4,5,29,30,31,32]. However, differences in study design and data collection impair a reliable head-to-head comparison between our results and those of the mentioned previous studies [4,5,29,30,31,32]. Using our comprehensive OGS-specific approach, we demonstrated that achieving similar outcomes in high- and regular-risk groups is possible, with OGS-treated patients exhibiting similar FACE-Q reports to matched healthy individuals.…”

“…However, we do not recommend that this particular cohort of patients receive the conventional OGS approach. The current OGS-related outcomes should be interpreted as being obtained by a national reference hospital [9,10,11,12,13,14,15,16,17,18] for OGS; the hospital is considered a high-volume center with surgeons and anesthesiologists who manage a high volume of patients [29,30,31] by using a comprehensive multidisciplinary team-based OGS approach (integration of technical expertise with advanced technologies) associated with condition-specific guidelines for perioperative care. An increase in operative volume has been associated with benefits in reducing complications for patients undergoing various surgical procedures, including OGS [29,30,31,48].…”

“…The current OGS-related outcomes should be interpreted as being obtained by a national reference hospital [9,10,11,12,13,14,15,16,17,18] for OGS; the hospital is considered a high-volume center with surgeons and anesthesiologists who manage a high volume of patients [29,30,31] by using a comprehensive multidisciplinary team-based OGS approach (integration of technical expertise with advanced technologies) associated with condition-specific guidelines for perioperative care. An increase in operative volume has been associated with benefits in reducing complications for patients undergoing various surgical procedures, including OGS [29,30,31,48]. The regionalization of all OGS patients to high-volume centers is an ongoing debate [29,30,31], but based on this study and the rationale from previous surgical experiences [29,30,31,48,49], patients with high-risk conditions should receive OGS procedures in structured, specialized centers.…”