Complications related to orthognathic surgery: A 10-year experience in oral and maxillofacial training center

Damrongsirirat, Napat; Kaboosaya, Boosana; Siriwatana, Kiti; Subbalekha, Keskanya; Jansisyanont, Pornchai; Pimkhaokham, Atiphan

doi:10.1016/j.jcms.2021.11.011

Cited by 12 publications

(13 citation statements)

References 32 publications

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“…As in current works, data were collected from one single surgical center. They are not complying with the heterogeneity of surgical and medical conditions between different institutions [ 33 , 36 , 65 ], not to mention reports of single-surgeon experiences, which describe in general lower complication rates, compared to single- and multi-institutional studies [ 17 , 32 , 66 ]. While the few multi-institutional studies focus on several subgroups, such as type of surgery or elderly patients, we try to fill the gap of comprehensive investigations in OS, adjusted to state-to-the-art surgical techniques [ 20 , 21 , 67 ].…”

Section: Discussionmentioning

confidence: 99%

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

Knoedler

Baecher

Hoch

et al. 2023

JCM

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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.

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Section: Discussionmentioning

confidence: 99%

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

Knoedler

Baecher

Hoch

et al. 2023

JCM

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“…It is well documented that increased operating time is directly correlated to complications in several surgical fields and specifically in several areas of oral and maxillofacial surgery including orthognathic surgery. [39][40][41] Within the scope of oral maxillofacial surgery, publications evaluating serum albumin as a prognostic marker have focused on head and neck cancer (HNC) cases. Several studies have found that in head and neck cancer patients undergoing ablative operations, low serum albumin was not only a prognostic indicator of significantly higher infection rates but also tumor progression and decreased overall survival rates.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, many studies have evaluated operative time as a predictive marker for complications. It is well documented that increased operating time is directly correlated to complications in several surgical fields and specifically in several areas of oral and maxillofacial surgery including orthognathic surgery 39–41 …”

Section: Discussionmentioning

confidence: 99%

Preoperative Nutritional Laboratory Values, Demographics, and Wound Healing Following Facial Trauma Surgery: Which Variables Predict Postoperative Complications?

Fahmy

Clegg

Deek

et al. 2023

Journal of Craniofacial Surgery

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In individuals who have sustained maxillofacial trauma, inadequate nutrition is often a sequela and may lead to complications. The purpose of this study was to investigate the association between preoperative laboratory values and postoperative complications in patients with maxillofacial trauma requiring surgical intervention.A retrospective cohort study of patients with maxillofacial trauma requiring surgical repair from 2014 to 2020 was performed at a single academic Level I Trauma Center. The primary predictor variables were preoperative laboratory values including serum albumin, white blood cell count, absolute neutrophil count, and lymphocyte count. Complications related to surgical reconstruction of facial injuries represented the primary outcome variable.The patient cohort included 152 patients, of whom 50 (32.9%) were female. When controlling for all other variables, female gender (odds ratio = 2.08, 95% confidence interval, 1.02-4.21; P = 0.04) and number of procedures performed (P = 0.02) were the only statistically significant predictors of postoperative complications. There were no significant differences between the complication groups for age (P = 0.89), injury severity score (P = 0.59), hospital length of stay (P = 0.30), serum albumin (P = 0.86), hemoglobin (P = 0.06), white blood cell count (P = 0.20), absolute neutrophil count (P = 0.95), lymphocyte count (P = 0.23), or absolute neutrophil/lymphocyte count ratio (P = 0.09).In this study, it was found that only gender and the number of procedures performed significantly predicted postoperative complications, while preoperative nutritional laboratory values did not. Further study with a larger cohort of patients is likely required.

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“…In addition, osteotomies are typically extensive, increasing the surface area of exposed medullary bone that tends to ooze 5. Finally, the complexity of orthognathic surgery typically leads to prolonged operating time and concomitant increased blood loss 6…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of prophylactic tranexamic acid versus placebo or no intervention for reducing blood loss in healthy patients undergoing orthognathic surgery: a systematic review protocol

Baghaie

Shukla

Stone

et al. 2022

JBI Evidence Synthesis

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Objective: The objective of this review is to evaluate the effectiveness of perioperative prophylactic tranexamic acid for reducing blood loss in orthognathic surgery in healthy patients. Introduction: Orthognathic surgery can cause significant hemorrhage, which requires postoperative blood transfusions. The most widely studied pharmaceutical adjunct for reducing blood loss is tranexamic acid, a synthetic amino acid that reversibly inhibits plasminogen activation. It is widely used and validated in other surgical procedures to limit blood loss; however, it is not a gold standard in orthognathic surgery. Inclusion criteria: We will include clinical trials comparing tranexamic acid to appropriate controls. The primary outcomes are intraoperative blood loss, change in hematocrit/hemoglobin level, and need for blood transfusion. Secondary outcomes include operating time, length of hospital stay, and adverse reactions. Studies of patients with pre-existing coagulopathies and those undergoing only minor orthognathic surgery (eg, genioplasty) will be excluded. Methods: We will search 3 electronic databases (PubMed, Embase, and Cochrane Library) from database inception. Titles, abstracts, and full-text papers will be assessed against the inclusion criteria by 2 independent reviewers. Risk of bias will be assessed using the Cochrane Risk of Bias 2.0 tool. Data will be extracted by 2 independent reviewers. Meta-analysis will be conducted for all outcomes where appropriate, with weighted mean differences used for intraoperative blood loss, changes in hematocrit/hemoglobin levels, operation time, and length of stay; and risk ratio for transfusion rates and adverse outcomes. Certainty of the evidence will be presented using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Systematic review registration number: PROSPERO CRD42022314403

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Complications related to orthognathic surgery: A 10-year experience in oral and maxillofacial training center

Cited by 12 publications

References 32 publications

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

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

Preoperative Nutritional Laboratory Values, Demographics, and Wound Healing Following Facial Trauma Surgery: Which Variables Predict Postoperative Complications?

Effectiveness of prophylactic tranexamic acid versus placebo or no intervention for reducing blood loss in healthy patients undergoing orthognathic surgery: a systematic review protocol

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