GP6d - Readmission after Orthognathic Surgery

Abstract:

Purpose:
The purpose of this study is to evaluate the overall readmission rate and identify the associated risk factors. Although studies have documented complications after orthognathic surgery,1,2 there is very limited information regarding specific reasons for readmission after such procedures.

Materials and methods:
The researchers performed a retrospective review of records of all patients who underwent orthognathic surgery between 2015 and 2019, with a single surgeon. Readmission was defined as an unexpected admission to the hospital, with or without return to the operating room within a 1-year postoperative period. Study variables included gender, age, ASA status, type of surgery, concomitant third molar extraction, concomitant genioplasty, duration of surgery, resident PGY level involvement, and duration of hospitalization.

Methods of data analysis:
Bivariate associations were calculated between variables and readmission status. Specifically, Chi-square or Fisher’s Exact tests were used to compare categorical variables, as appropriate, and a 2-sample T-test was used to compare continuous variables. To adjust for potential confounders, a multivariate logistical regression analysis was performed. The number of operative jaws was chosen a priori as a clinically relevant confounder of the association between duration of initial hospitalization and readmission, as the duration of initial hospitalization was longer with increased number of simultaneous operations. To evaluate the relative importance of statistically significant predictors, the change in the c statistic was evaluated.

Results:
A total of 701 patients (418 females and 283 males) with a mean age of 25.86 years (14-66 years) were included in the study. A mix of ASA 1 (58.92%), ASA 2 (38.66%), and ASA 3 (2.43%) patients comprised the study population. The overall readmission rate was 9.7%. Of the 68 readmissions, 12 patients (17.6%) were managed non-surgically and 56 patients (82.4%) required a return to the operating room. The most common reason for readmission was infection (n = 11) and for re-operation was hardware removal (n = 24). Other reasons for reoperation were non-union of osteotomy (n = 2), oronasal fistula (n = 2), subjective esthetic concerns (n = 2), malocclusion (n = 3), trismus (n = 5), bleeding (n = 10). Age, gender, type of surgery, third molar extraction, genioplasty, duration of surgery, and resident training level were not found to be predictors for readmission after orthognathic surgery.

Outcomes data:
There was an association between ASA status and readmission (P-value .0042). ASA 2 and 3 patients had 1.77 times (95% Confidence Interval: 1.05, 2.97) and 5.32 times (95% Confidence Interval: 1.75, 16.10) greater chance of being readmitted compared to ASA 1 patients, respectively. After adjusting for the number of operative jaws, duration of hospitalization was also associated with readmission (P-value .0162). Overall, ASA classification was more predictive of readmission than duration of hospitalization.

Conclusion:
Only ASA classification and duration of initial hospitalization after orthognathic surgery are significant risk factors for readmission of patients within the first postoperative year.

References: 1. Bacos J, Turin SY, Vaca EE, Gosain AK: Major complication and 30-day morbidity for single jaw versus bimaxillary orthognathic surgery as reported by NSQIP. Cleft Palate Craniofac J 56:6:705-510, 2019 2. Peacock ZS, Lee CCY, Klein KP, Kaban LB: Orthognathic surgery in patients over 40 years of age: indications and special considerations. J Oral Maxillofac Surg 72:10:1995-2004, 2014