P01 - Current Orthognathic Surgery Practice Patterns Among Academic OMS

Abstract: 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.1 The purpose of this study is to describe the practice patterns among US academic OMFS training centers.
The study design is cross-sectional. Data was collected through a survey of a sample Academic OMFS programs in the US. 573 surgeons were contacted and 85 responses were received. Descriptive and bivariate statistics were reported.
Respondents were 87% male and worked in full-time academic (80%), part-time academic (19%), or military settings (1%) (Table I). 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, 85% report a blood loss of less than 400 milliliters, and 93% reported a blood transfusion rate of < 1%. Seventy-five percent use a traditional non-invasive blood pressure cuff for intraoperative blood pressure monitoring, 22% utilize invasive arterial continuous monitoring, and 2% utilize non-invasive continuous monitoring. Perioperative choice of antibiotic was cefazolin (54%), ampicillin (31%), clindamycin (9%), and other (6%). For postoperative antibiotic choice, 47% use amoxicillin, 37% cefalexin, 8% clindamycin, 8% other. Thirty-three percent utilize postoperative antibiotics for approximately 24 hours after surgery, 31% for 7 days after surgery, and 26% for 5 days after surgery. The majority of respondents (73%) use steroids greater than 48 hours after surgery.
Our response rate was similar to other survey based research, and all regions were represented. 2 Respondent surgical volume was found to show statistically significant differences in the percentage of segmental Le Fort I osteotomies (P < 0.02) (Table II). Lower volume surgeons had the highest percentage of single-piece Le Fort I osteotomies. Surgical volume also showed significant differences in average surgical time for bimaxillary surgery (P=0.05), use of tranexamic acid (P < 0.01), and use of a foley catheter (P < 0.01). Surgeon volume was not associated with surgeon age or years of practice.
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. Learners will grasp the variety of current practice patterns in US academic OMS centers. They will be inspired to seek evidence-based research to validate their own methods of care. Patient outcomes will increase after a clinical guideline for orthognathic surgery emerges with the best, research-guided, practice patterns.

References:
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