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Yun CW, Kim KH, Lee W, Kim SH. Comparative Analysis of Temperature-Responsive Hydrogel (PF 72) for Postoperative Pain After Bimaxillary Surgery: A Retro-spective Study. Aesthetic Plast Surg 2024; 48:1271-1275. [PMID: 38326500 DOI: 10.1007/s00266-023-03846-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 12/30/2023] [Indexed: 02/09/2024]
Abstract
Bimaxillary surgery is a painful invasive procedure in plastic surgery. Pain control is typically achieved using intravenous analgesics. We aimed to investigate the efficacy of a novel temperature-responsive hydrogel, PF72, mixed with ropivacaine, as a local pain management solution when applied directly to the surgical site following orthognathic surgery. The study was conducted from October 2022 to July 2023 and included a cohort of 40 candidates for orthognathic surgery, encompassing LeFort I maxillary ostectomy and sagittal split ramus osteotomy. The participants were divided into an Injection group (n = 20), where PF72 was administered at the surgical site before the orthognathic surgery, and a Control group (n = 20), which relied solely on intravenous analgesics. Pain was evaluated at 3, 6, 24, 48, and 72 h after surgery using a numerical rating scale (NRS). The mean NRS scores at 24 h were 6.35 and 4 for the Control and Injection groups, respectively. The mean NRS scores at 72 h were 3.4 and 2.55 for the Control and Injection groups, respectively. Patients who received PF72 experienced less pain than those who received intravenous analgesics. These findings underscore the potential of PF72 as an effective alternative for enhancing pain management in patients undergoing orthognathic surgery.Level of Evidence III Therapeutic study. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Chang Woon Yun
- Department of Plastic and Reconstructive Surgery, View Plastic Surgery, Seoul, Republic of Korea
| | - Ki Hyun Kim
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singillo, Yongdeongpo-gu, Seoul, 07441, Republic of Korea
| | - Won Lee
- Department of Plastic and Reconstructive Surgery, Yonsei E1 Plastic Surgery Clinic, Anyang, Republic of Korea
| | - Seong Hwan Kim
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singillo, Yongdeongpo-gu, Seoul, 07441, Republic of Korea.
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Pekkari C, Lund B, Davidson T, Naimi-Akbar A, Marcusson A, Weiner CK. Cost analysis of orthognathic surgery: outpatient care versus inpatient care. Int J Oral Maxillofac Surg 2024:S0901-5027(24)00053-5. [PMID: 38429199 DOI: 10.1016/j.ijom.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 03/03/2024]
Abstract
With limited healthcare resources, it is important to provide the right level and form of care. The aim of this study was to determine whether selected single-jaw orthognathic surgery in outpatient care (OPC) generates lower healthcare costs than in inpatient care (IPC). The costs of surgically assisted rapid maxillary expansion (SARME), Le Fort I osteotomy (LFI), and bilateral sagittal split osteotomy (BSSO) were calculated for 165 patients, 107 treated in OPC and 58 in IPC. Additionally, costs for revisits, emergency visits, emergency phone calls, re-operations, and plate removal during the first 12 months postoperatively were recorded. The total mean costs of the different operations including revisits, emergency visits, and phone calls were 34.2-48.8% lower in OPC than in IPC at 12 months postoperatively. Operation costs were lower for LFI in OPC (P = 0.009) and for SARME in IPC (P = 0.007). Anaesthesia costs were lower for LFI (P < 0.001) and BSSO (P < 0.001) in OPC, and there were fewer revisits (P = 0.001) and lower costs (P = 0.002) after LFI in OPC compared to IPC. This study showed that selected single-jaw orthognathic surgeries in outpatient care are associated with lower healthcare costs compared to inpatient care.
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Affiliation(s)
- C Pekkari
- Department of Dental Medicine, Division of Oral Diagnostics and Rehabilitation, Karolinska Institutet, Huddinge, Sweden; Department of Oral and Maxillofacial Surgery, Eastman Institute, Folktandvården Stockholm AB, Stockholm, Sweden.
| | - B Lund
- Department of Dental Medicine, Division of Oral Diagnostics and Rehabilitation, Karolinska Institutet, Huddinge, Sweden; Medical Unit of Plastic Surgery and Oral and Maxillofacial Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - T Davidson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Health Technology Assessment-Odontology (HTA-O), Faculty of Odontology, Malmö University, Malmö, Sweden
| | - A Naimi-Akbar
- Department of Dental Medicine, Division of Oral Diagnostics and Rehabilitation, Karolinska Institutet, Huddinge, Sweden; Department of Oral and Maxillofacial Surgery, Eastman Institute, Folktandvården Stockholm AB, Stockholm, Sweden; Health Technology Assessment-Odontology (HTA-O), Faculty of Odontology, Malmö University, Malmö, Sweden
| | - A Marcusson
- Maxillofacial Unit in Linköping, and Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - C K Weiner
- Department of Dental Medicine, Division of Oral Diagnostics and Rehabilitation, Karolinska Institutet, Huddinge, Sweden; Department of Oral and Maxillofacial Surgery, Gävle Hospital, Folktandvården Gävleborg, Gävleborg, Sweden
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Abstract
BACKGROUND The purpose of this study was to evaluate the influence of socioeconomic factors on access to congenital hand surgery care, hospital admission charges, and analyze these geographic trends across regions of the country. METHODS Retrospective cohort study was conducted of congenital hand surgery performed in the United States from 2010 through 2020 using the Pediatric Health Information System. Multivariate regression was used to analyze the impact of socioeconomic factors. RESULTS During the study interval, 5531 pediatric patients underwent corrective surgery for congenital hand differences, including syndactyly repair (n = 2439), polydactyly repair (n = 2826), and pollicization (n = 266). Patients underwent surgery at significantly earlier age when treated at above-median case volume hospitals (P < .001). Patients with above-median income (P < .001), non-white race (P < .001), commercial insurance (P < .001), living in an urban community (P < .001), and not living in an underserved area (P < .001) were more likely to be treated at high-volume hospitals. Nearly half of patients chose to seek care at a distant hospital rather than the one locally available (49.5%, n = 1172). Of those choosing a distant hospital, most patients chose a higher-volume facility (80.9%, n = 948 of 1172). On multivariate regression, white patients were significantly more likely to choose a more distant, higher-volume hospital (P < .001). CONCLUSIONS Socioeconomic and geographic factors significantly contribute to disparate access to congenital hand surgery across the country. Patients with higher socioeconomic status are more likely to be treated at high-volume hospitals. Treatment at hospitals with higher case volume is associated with earlier age at surgery and decreased hospital admission charges.
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Prevost A, Lauwers F, Varazzani A, Poulet V, Mure M, Lopez R, Cavallier Z. Outpatient orthognathic surgery: a prospective study of predictive factors for the length of hospital stays. Clin Oral Investig 2023; 27:6781-6788. [PMID: 37792221 DOI: 10.1007/s00784-023-05290-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/27/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVES Transitioning 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 significantly associated with "successful" outpatient orthognathic treatment. The secondary objective was to determine the factors significantly associated with prolonged hospital stays (≥ 2 nights). MATERIALS AND 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 A total of 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 clarified. 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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Affiliation(s)
- Alice Prevost
- Plastic and Maxillo-Facial Surgery Department, CHU Purpan, University Hospital Center of Toulouse, Place du Docteur Baylac, 31059, Toulouse Cedex, France.
| | - Frédéric Lauwers
- Plastic and Maxillo-Facial Surgery Department, CHU Purpan, University Hospital Center of Toulouse, Place du Docteur Baylac, 31059, Toulouse Cedex, France
| | - Andréa Varazzani
- Plastic and Maxillo-Facial Surgery Department, Hospices Civils de Lyon, Lyon-Sud Hospital-Claude-Bernard Lyon 1 University, 165 Chemin du Grand-Revoyet, 69310, Pierre-Bénite, France
| | - Vinciane Poulet
- Plastic and Maxillo-Facial Surgery Department, CHU Purpan, University Hospital Center of Toulouse, Place du Docteur Baylac, 31059, Toulouse Cedex, France
| | - Marion Mure
- Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, Place du Docteur Baylac, 31059, Toulouse, France
| | - Raphael Lopez
- Plastic and Maxillo-Facial Surgery Department, CHU Purpan, University Hospital Center of Toulouse, Place du Docteur Baylac, 31059, Toulouse Cedex, France
| | - Zoé Cavallier
- Plastic and Maxillo-Facial Surgery Department, CHU Purpan, University Hospital Center of Toulouse, Place du Docteur Baylac, 31059, Toulouse Cedex, France
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Shibata M, Takahara N, Kaneko T, Oki M, Sasaki Y, Tomomatsu N, Kurasawa Y, Nakakuki K, Yoda T. Risk factors for postoperative facial swelling at 1 week after bimaxillary orthognathic surgery in Class III patients. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101516. [PMID: 37236352 DOI: 10.1016/j.jormas.2023.101516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/06/2023] [Accepted: 05/21/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To quantify facial swelling at 1 week after Le Fort I osteotomy and bilateral sagittal splitting ramus osteotomy in Class III patients and to identify factors contributing to the swelling based on clinical, morphologic, and surgical variables. STUDY DESIGN Data from 63 patients were examined in this single-center, retrospective study. Facial swelling was quantitatively measured by superimposing computed tomography data taken in the supine position at 1 week and 1 year postoperatively and extracting the area of maximum intersurface distance. Age, sex, body mass index, thickness of subcutaneous tissue, and of masseter muscle, maxillary length (A-VRP), mandibular length (B-VRP), and posterior maxillary height (U6-HRP), surgical movement (ΔA-VRP, ΔB-VRP, ΔU6-HRP), drainage method, and usage of facial bandages were examined. Multiple regression analysis was performed using the above factors. RESULTS The median swelling at 1 week postoperatively was 8.35 IQR (5.99-11.47) mm. Multiple regression analysis revealed three factors that were significantly associated with facial swelling: Use of postoperative facial bandages (P=0.03), masseter muscle thickness (P=0.03), and ΔB-VRP (P=0.04). CONCLUSION Absence of a facial bandage, thin masseter muscle, and large horizontal mandibular movement are risk factors for facial swelling at 1 week postoperatively.
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Affiliation(s)
- Mari Shibata
- Department of Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan
| | - Namiaki Takahara
- Department of Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan.
| | - Toma Kaneko
- Center for Advanced Dental Clinical Education of Dental Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan
| | - Meiko Oki
- Department of Basic Oral Health Engineering, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan
| | - Yoshiyuki Sasaki
- Department of Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan
| | - Nobuyoshi Tomomatsu
- Department of Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan
| | - Yasuhiro Kurasawa
- Department of Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan
| | - Koichi Nakakuki
- Department of Acute Critical Care and Disaster Medicine, Graduate School for Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan
| | - Tetsuya Yoda
- Department of Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan
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National Trends in Orthognathic Surgery: A Multi-Institutional Analysis of 6640 Patients. J Craniofac Surg 2023:00001665-990000000-00562. [PMID: 36804875 DOI: 10.1097/scs.0000000000009188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 10/09/2022] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND LeFort I osteotomy (LF1) and bilateral sagittal split osteotomy (BSSO) have unique operative challenges and inherent anatomic considerations that predispose to certain adverse outcomes, yet their respective complication profiles continue to be debated given conflicting results from single-center investigations. The purpose of this study is to perform a multi-institutional analysis of complications, socioeconomic trends, and financial charges associated with orthognathic surgery. METHODS A retrospective cohort study was conducted of orthognathic procedures performed in the United States from 2010 through 2020 using the Pediatric Health Information System. Patients younger than 12 years of age were excluded. Medical complications, surgical complications, and admission costs were compared across procedures. Socioeconomic determinants and trends across regions of the country were also analyzed. RESULTS During the study interval, 6640 patients underwent orthognathic surgery, including LF1 (59.2%, n=3928), BSSO (14.4%, n=959), and double-jaw surgery (26.4%, n=1753). Patients undergoing LF1 were more likely to experience overall complications (P<0.001), infections (P<0.001), and blood transfusions (P<0.001) than those undergoing BSSO. High-volume hospitals were more likely to perform double-jaw procedures than other hospitals (P<0.001), yet high-volume hospitals were less likely to have surgical complications (P=0.014). Patient admission charges related to orthognathic operations at high-volume hospitals were less than other hospitals (P<0.001). Household income was higher for orthognathic procedures performed at high-volume hospitals (P<0.001). White patients were 1.5 times more likely to choose a farther, higher volume hospital for orthognathic surgery than the one locally available (P=0.041). CONCLUSIONS LeFort I osteotomy procedures had higher infection and transfusion rates than BSSO procedures. High-volume hospitals were more likely to perform double-jaw procedures, yet high-volume hospitals had fewer complications and decreased admission charges. Future study will be needed to further elucidate case-mix index details and socioeconomic determinants of health contributing to these disparities.
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Ferrara JT, Tehrany GM, Chen Q, Sheinbaum J, Mora-Marquez J, Hernandez Conte A, Rudikoff AG. Evaluation of an Enhanced Recovery After Surgery Protocol (ERAS) for Same-Day Discharge and Reduction of Opioid Use Following Bimaxillary Orthognathic Surgery. J Oral Maxillofac Surg 2021; 80:38-46. [PMID: 34339616 DOI: 10.1016/j.joms.2021.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE This study sought to evaluate the impact of implementation of a comprehensive enhanced recovery after surgery (ERAS) protocol upon patients undergoing maxillary and mandibular osteotomy (MMO). METHODS This study was a retrospective, observational study of patients undergoing MMO. The study intervention group consisted of patients who underwent MMO with utilization of ERAS protocol compared to control group without ERAS. The primary outcome measure was same-day discharge. Secondary outcome measures included hospital length-of-stay (LOS), overall dose of opioids administered, total operating room time, estimated blood loss, need for hospital admission, and complications. Descriptive statistics and multivariable analysis were computed and the P value was set at .05. RESULTS We compared 189 patients who underwent MMO with and without genioplasty and received a comprehensive surgical and multimodal analgesic regimen to 170 control patients who underwent MMO with or without genioplasty without receiving the above protocol. There was a statistically significant decrease in hospital admission post-surgery (83.5% - control vs 22.2% - intervention) and in overall hospital length-of-stay in the intervention group. There was no change in the overall operating room time, but there was a decrease in blood loss in the intervention group. CONCLUSION The results suggest that use of a comprehensive ERAS protocol for patients undergoing MMO will decrease hospital length-of-stay without an increase in readmissions or complications. Future studies are needed to evaluate if pain scores, postoperative nausea and vomiting, and other complications differed when using a ERAS protocol.
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Affiliation(s)
- Jammie T Ferrara
- Partner, Southern California Permanente Medical Group; Attending Anesthesiologist, Department of Anesthesiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA.
| | - Gabriella M Tehrany
- Partner, Southern California Permanente Medical Group; Attending Surgeon, Department of Head & Neck Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - Qiaoling Chen
- Biostatistician, Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Justin Sheinbaum
- Resident Physician, Department of Oral & Maxillofacial Surgery, University of California Los Angeles Medical Center, Los Angeles, CA
| | - Janet Mora-Marquez
- Biostatistician, Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Antonio Hernandez Conte
- Partner, Southern California Permanente Medical Group; Attending Anesthesiologist, Department of Anesthesiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - Andrew G Rudikoff
- Partner, Southern California Permanente Medical Group; Attending Anesthesiologist, Department of Anesthesiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
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Adequacy of the Italian National Tariff for Orthognathic Surgery: A Cost Analysis Using the Activity Based Costing (ABC) Method. J Craniofac Surg 2021; 32:840-843. [PMID: 32868720 DOI: 10.1097/scs.0000000000006962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT The reduced economic resources in health care and the consequent spending review have brought great interest in surgical costs. The aim of the study is to determine direct hospital costs for Orthognathic procedures using the Activity based costing method and evaluate the adequacy of the refund provided by the Italian National Health Service. From January 2017 to December 2017 9 consecutive patients underwent the following Orthognathic procedures at IRCCS Casa Sollievo della Sofferenza (San Giovanni Rotondo, Italy): bimaxillary osteotomy (n = 7), Le Fort I osteotomy (n = 1) and Bilateral Sagittal Split Osteotomy (BSSO) (n = 1). Activity based costing was used to obtain costs of each single hospitalization split into surgery, instay, and services. The mean total cost for a bimaxillary osteotomy was 7596.40€. We observed a total cost of 3925.00€ for Le Fort I osteotomy and of 4334.50€ for BSSO. The refund of 4378.00€ provided by the Italian National Health Service system for Orthognathic surgery seems insufficient to cover costs of bimaxillary osteotomy but consistent for single osteotomy (Le Fort I or BSSO).
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Daws S. Assent for Orthognathic Surgery: Features, Challenges, and Benefits. Cleft Palate Craniofac J 2020; 58:391-395. [PMID: 32815374 DOI: 10.1177/1055665620951062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The ideal age to undergo orthognathic surgery approximates the age of majority, and as a result a considerable portion of the patient population undergoing orthognathic surgery are legal minors. When a patient cannot legally provide consent, assent is often sought. Assent for surgical orthodontics is complicated by particular changes in cognitive variables during adolescence, the multiphased and multi-provider treatment course, and the intervention's elective nature. Ultimately, inclusion of a high-quality assent process can help identify patients most likely to benefit from orthognathic surgery and increase patient satisfaction.
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Affiliation(s)
- Steven Daws
- Resident, Department of Oral & Maxillofacial Surgery, 21927Ascension Macomb-Oakland Hospital, Warren, MI, USA
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Jodeh DS, Nguyen ATH, Rottgers SA. Le Fort 1 and Bimaxillary Osteotomies Increase the Length of Stay but not Postoperative Morbidity Compared to Mandibular Osteotomies and Single Jaw Procedures. J Craniofac Surg 2020; 31:1734-1738. [PMID: 32371693 DOI: 10.1097/scs.0000000000006514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The purpose of this study is to examine the association between type of facial osteotomies performed during orthognathic surgery and postoperative outcomes including complications, length of stay, and readmission. METHODS A retrospective review of orthognathic surgery cases from the Pediatric Health Information System (PHIS) database from 2004 to 2014 was undertaken. Osteotomy procedures were classified as Le Fort 1 (LF 1), Mandibular osteotomy, Genioplasty or their combinations. Primary outcome variable was major complications. Secondary outcomes included postoperative LOS > 1 day and 90-day readmission. Random-intercept logistic regression models were utilized to assess the association between the type of osteotomy performed and the outcomes. Bonferroni approach was used to account for multiple comparisons. RESULTS The sample included 5413 patients, with a mean age of 17.1 ± 1.68 years and 60.65% were female. The most common procedures were LF1 (39.4%), followed by bimaxillary surgery (23%). Major complications occurred in 8.57% of patients, postoperative LOS > 1 day in 52.4% and 90-day all-cause readmission in 11.16%. In adjusted analyses comparing LF1 compared to mandibular osteotomies, there were no significant differences for major complications (OR = 0.78), 90-day readmission rate (OR = 0.98). However, LF1 was associated with an increased odds for LOS compared to mandibular osteotomies (OR = 1.42). Addition of osteotomies is associated with a significant increase in LOS (P < 0.001). CONCLUSIONS Patients undergoing orthognathic surgery demonstrated increased length of stay for LF1 or bimaxillary osteotomies. Osteotomy type did not impact the odds of readmission or complications. The trends revealed should be helpful for patient counseling.
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Affiliation(s)
- Diana S Jodeh
- Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital
| | - Anh Thy H Nguyen
- Health Informatics, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - S Alex Rottgers
- Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital
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The Outcomes Movement: Reflection from the Former Outcomes Editor with a View of the Future. Plast Reconstr Surg 2020; 145:590-592. [DOI: 10.1097/prs.0000000000006429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Chou PY, Denadai R, Chen C, Pai BCJ, Hsu KH, Chang CT, Pascasio D, Lin JAJ, Chen YR, Lo LJ. Comparison of Orthognathic Surgery Outcomes Between Patients With and Without Underlying High-Risk Conditions: A Multidisciplinary Team-Based Approach and Practical Guidelines. J Clin Med 2019; 8:E1760. [PMID: 31652792 PMCID: PMC6912447 DOI: 10.3390/jcm8111760] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 10/16/2019] [Accepted: 10/22/2019] [Indexed: 02/05/2023] Open
Abstract
Orthognathic surgery (OGS) has been successfully adopted for managing a wide spectrum of skeletofacial deformities, but patients with underlying conditions have not been treated using OGS because of the relatively high risk of surgical anesthetic procedure-related complications. This study compared the OGS outcomes of patients with and without underlying high-risk conditions, which were managed using a comprehensive, multidisciplinary team-based OGS approach with condition-specific practical perioperative care guidelines. Data of surgical anesthetic outcomes (intraoperative blood loss, operative duration, need for prolonged intubation, reintubation, admission to an intensive care unit, length of hospital stay, and complications), facial esthetic outcomes (professional panel assessment), and patient-reported outcomes (FACE-Q social function, psychological well-being, and satisfaction with decision scales) of consecutive patients with underlying high-risk conditions (n = 30) treated between 2004 and 2017 were retrospectively collected. Patients without these underlying conditions (n = 30) treated during the same period were randomly selected for comparison. FACE-Q reports of 50 ethnicity-, sex-, and age-matched healthy individuals were obtained. The OGS-treated patients with and without underlying high-risk conditions differed significantly in their American Society of Anesthesiologists Physical Status (ASA-PS) classification (p < 0.05), Charlson comorbidity scores, and Elixhauser comorbidity scores. The two groups presented similar outcomes (all p > 0.05) for all assessed outcome parameters, except for intraoperative blood loss (p < 0.001; 974.3 ± 592.7 mL vs. 657.6 ± 355.0 mL). Comparisons with healthy individuals revealed no significant differences (p > 0.05). The patients with underlying high-risk conditions treated using a multidisciplinary team-based OGS approach and the patients without the conditions had similar OGS-related outcomes.
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Affiliation(s)
- Pang-Yun Chou
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan.
| | - Rafael Denadai
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan.
| | - Chit Chen
- Department of Anesthesia, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan.
| | - Betty Chien-Jung Pai
- Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan.
| | - Kai-Hsiang Hsu
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan, Chang Gung University, Taoyuan 333, Taiwan.
| | - Che-Tzu Chang
- Division of Rheumatology, Allergy, and Immunology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan.
| | - Dax Pascasio
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan.
| | - Jennifer Ann-Jou Lin
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan.
| | - Yu-Ray Chen
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan.
| | - Lun-Jou Lo
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan.
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Olkun HK, Borzabadi-Farahani A, Uçkan S. Orthognathic Surgery Treatment Need in a Turkish Adult Population: A Retrospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16111881. [PMID: 31141986 PMCID: PMC6603578 DOI: 10.3390/ijerph16111881] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 05/18/2019] [Accepted: 05/24/2019] [Indexed: 01/01/2023]
Abstract
Objectives: Limited information exists on orthognathic procedures and respective dentofacial deformities in Turkey. This retrospective study assessed the orthognathic surgery procedures in two universities, using the Index of Orthognathic Functional Treatment Need (IOFTN), and compared the IOFTN grades according to gender as well as sagittal and vertical skeletal relationships. Material and Methods: Records of 200 consecutive patients (120 females, 80 males, mean age = 23.4 (SD: 5.4) years) who received orthognathic treatment (2014–2018) were analyzed. Sagittal (ANB angle) and vertical skeletal type (GoGnSN angle), osteotomies, and IOFTN scores were recorded. Results: Class III, II, and I malocclusions formed 69%, 17.5%, and 13.5% of the samples, respectively. Class III skeletal relationships (69%) and high-angle cases (64%) were the most prevalent (p < 0.05). IOFTN scores were unevenly distributed among genders (p < 0.05) and the prevalent scores were 5.3 (40.5%), 4.3 (15.5%), 5.4 (13%), and 5.2 (7.5%), with 94% scoring 4 or 5 (great and very great functional need). Bimaxillary osteotomies were the most prevalent (55%), followed by LeFort I (32%), and 26% had genioplasty. Conclusion: IOFTN is a reliable tool to identify patients in need of orthognathic surgery. Class III malocclusions and Class III sagittal skeletal relationships were more common in this sample. Comparatively, a higher number of patients had genioplasty as a part of their treatment.
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Affiliation(s)
- Hatice Kübra Olkun
- Department of Orthodontics, School of Dentistry, İstanbul Okan University, İstanbul 34959, Turkey.
| | - Ali Borzabadi-Farahani
- Orthodontics, Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, 00183 Rome, Italy.
- Finchley Orthodontics, North Finchley, London N12 9EN, UK.
| | - Sina Uçkan
- Department of Oral and Maxillofacial Surgery, School of Dentistry, İstanbul Medipol University, İstanbul 34214, Turkey.
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Balakrishnan K, Moriarty JP, Rosedahl J, Driscoll CL, Borah BJ. Predictors of High Costs of Care among Otolaryngology Patients. Otolaryngol Head Neck Surg 2019; 161:271-277. [DOI: 10.1177/0194599819838843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives Identify predictors of high-cost otolaryngology care. Study Design Cross-sectional. Setting Tertiary academic multispecialty hospital. Subjects/Methods All patients undergoing ≥1 otolaryngologic procedures from 2011 to 2015. Encounter costs were standardized using previously described methods approximating Medicare reimbursement. Patients were stratified by adult/pediatric and inpatient/outpatient. “Outliers” were defined as total encounter costs ≥95th percentile. Logistic regression measured predictors of outlier status. Results In total, 2433 adult inpatient encounters (95th percentile $57,611), 10,031 adult outpatient encounters ($10,772), 346 pediatric inpatient encounters ($84,639), and 3027 pediatric outpatient encounters ($8978) were included. For adult inpatient and outpatient, isolated head and neck oncologic procedures were the reference group. Among adult inpatients, laryngology and facial plastics procedures predicted higher odds of outlier status (odds ratio [OR] = 4.1 and 7.2). Involvement of multiple otolaryngology subspecialties increased the odds (OR = 4.7). Neck dissection and reconstructive procedures were the most common primary operations for adult inpatient outliers. For adult outpatients, several subspecialties had lower odds than head and neck (OR ≤0.44). Increased comorbidities predicted outliers for adult inpatient care (OR = 1.5); sex, age, race, and ethnicity did not. Cochlear implant was the most common primary operation among adult and pediatric outpatient outliers. Greater subspecialty involvement and increasing age predicted pediatric outpatient outliers (OR = 8.0 and 1.1); younger age and female sex predicted pediatric inpatient outliers (OR = 0.8 and 3.5). Airway procedures dominated pediatric inpatient outliers. Conclusion This is the first large-scale study of high-cost otolaryngology care across multiple subspecialties. Specific procedures and subspecialties and increased comorbidities predicted high-cost care. Contrary to previous studies, patient sex, race, and ethnicity did not.
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Affiliation(s)
- Karthik Balakrishnan
- Department of Otorhinolaryngology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
- Mayo Clinic Children’s Center, Rochester, Minnesota, USA
| | - James P. Moriarty
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jordan Rosedahl
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Colin L. Driscoll
- Department of Otorhinolaryngology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Bijan J. Borah
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
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Berlin NL, Steinbacher DM, Tuggle CT. Procedure Volume in Orthognathic Surgery: The Surgeon or the Hospital? J Oral Maxillofac Surg 2017; 75:2037. [PMID: 28735745 DOI: 10.1016/j.joms.2017.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 06/06/2017] [Indexed: 10/19/2022]
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Gupta A, Haring RS, Schneider EB. In Reply. J Oral Maxillofac Surg 2017; 75:2037-2038. [PMID: 28735744 DOI: 10.1016/j.joms.2017.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 06/22/2017] [Indexed: 10/19/2022]
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