Early Outcomes and Risk Factors in Orthognathic Surgery for Mandibular and Maxillary Hypo- and Hyperplasia: A 13-Year Analysis of a Multi-Institutional Database

Abstract

Background: Orthognathic surgery (OS) is a frequently performed procedure for the correction of dentofacial deformities and malocclusion. Research on OS is mostly limited to single-surgeon experience or single-institutional reports. We, therefore, retrospectively analyzed a multi-institutional database to investigate outcomes of OS and identify risk factors for peri- and postoperative complications. Methods: We reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2008–2020) to identify patients who underwent OS for mandibular and maxillary hypo- and hyperplasia. The postoperative outcomes of interest included 30-day surgical and medical complications, reoperation, readmission, and mortality. We also evaluated risk factors for complications. Results: The study population included 674 patients, 48% of whom underwent single jaw surgery, 40% double jaw surgery, and 5.5% triple jaw surgery. The average age was 29 ± 11 years, with an equal gender distribution (females: n = 336; 50%, males: n = 338; 50%). Adverse events were relatively rare, with a total of 29 (4.3%) complications reported. The most common surgical complication was superficial incisional infection (n = 14; 2.1%). While the multivariable analysis revealed isolated single lower jaw surgery (p = 0.03) to be independently associated with surgical complication occurrence, it also identified an association between the outpatient setting and the frequency of surgical complications (p = 0.03) and readmissions (p = 0.02). In addition, Asian ethnicity was identified as a risk factor for bleeding (p = 0.003) and readmission (p = 0.0009). Conclusion: Based on the information recorded by the ACS-NSQIP database, our analysis underscored the positive (short-term) safety profile of OS. We found OS of the mandible to be associated with higher complication rates. The calculated risk role of OS in the outpatient setting warrants further investigation. A significant correlation between Asian OS patients and postoperative adverse events was found. Implementation of these novel risk factors into the surgical workflow may help facial surgeons refine their patient selection and improve patient outcomes. Future studies are needed to investigate the causal relationships of the observed statistical correlations.

Patient safety in orthodontic care: a scoping literature review with proposal for terminology and future research agenda

“…The remaining sixteen studies reported risk assessments of orthodontic procedures or materials. These included safety assessment of dental radiography [ 23 ], bonding of brackets under general anaesthesia [ 24 ], orthodontic facebows [ 10 ], mini-implants [ 12 , 25 , 26 ], soft-tissue lasers in orthodontics [ 13 ], effect of orthodontic treatment on patients’ diet [ 14 ], eye safety of curing lights [ 27 ], safety of metal fixed appliance during magnetic resonance imaging (MRI) [ 28 ], pulp safety of various types of curing lights [ 29 ], wrong tooth extraction in orthodontics [ 30 – 32 ], orthodontic treatment by identifying orthodontic never events [ 33 ] and complications after orthognathic surgery [ 34 ]. These studies identified risks in orthodontic procedures or materials and proposed solutions to manage and minimise these risks.…”

“…Seven of the studies included provided information in the first category of the WHO’s research cycle on patient safety, which is “measuring harm” [ 4 , 7 – 9 , 19 , 22 , 34 ]. Sims et al conducted a postal survey on eye protection in the UK and found that ocular injuries were reported in 37.7% of all respondents involving orthodontists, assistants and patients [ 19 ].…”

“…In a similar investigation in hospital and private settings in Finland, Hiivala et al reported that orthodontic PSIs accounted for 3.6% of all dental PSIs [ 8 ]. Finally, a multi-centre retrospective review of orthognathic surgeries assessing complications and risk factors studied a population of 674 patients [ 34 ]. They reported that adverse events were rare (4.3%) with superficial incisional infection being the most common.…”

“…Twenty-one of the included studies identified the underlying causes of AEs that caused patient harm (WHO’s Category 2 “Understanding the causes”) [ 3 , 4 , 7 , 10 , 12 – 14 , 19 – 21 , 23 – 31 , 33 , 34 ]. In addition, twelve studies identified possible solutions that may be effective in reducing the occurrence of AEs (WHO’s Cycle Category 3 “Identifying solutions”) [ 4 , 10 , 12 , 13 , 19 – 21 , 23 – 25 , 31 , 32 ].…”

Measurement and Prediction of Sawing Characteristics Using Dental Reciprocating Saws: A Pilot Study on Fresh Bovine Scapula

“…Potential intraoperative adverse events in orthognathic surgery include abnormal hemorrhage due to infection or injury, fracture and split, osteonecrosis, etc. [25]. The mandible is identified as adverse-event-prone, probably due to its unique anatomical conditions, such as its masticatory muscle attachment, articulatory function, difficulties in visualizing the inferior alveolar neurovascular bundle and strict demands for osteotomy and fixation [26].…”