Current Orthognathic Surgery Practice Patterns Among Academic OMS

Abstract

Objective 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. The purpose of this study is to describe the practice patterns among US academic OMFS training centers. Design The study design is cross-sectional. Data was collected through a survey of the sample. Setting OMFS programs in the US. Participants Academic OMFS. 573 surgeons were contacted and 85 responses were received. Main Outcome Measure Descriptive and bivariate statistics were reported. Results Respondents were 87% male and worked in full-time academic (80%), part-time academic (19%), or military settings (1%). 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 (TXA), 85% report a blood loss of less than 400 milliliters, and 93% report a blood transfusion rate of <1%. Conclusion 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.

Thematic Analysis of Parental Experiences of Patients’ Orthognathic Surgery

“…Understanding parental perspectives can help inform providers in developing effective interdisciplinary treatment protocols 14 . There is variation in how orthognathic surgery is performed in the US without widely adapted clinical guidelines 22 . Although there is some broad guidance for assessment of patient psychosocial factors available, 23 the lack of consensus in surgical practice extends to a range of modalities for addressing patient and family needs with variable potential benefit.…”

“…14 There is variation in how orthognathic surgery is performed in the US without widely adapted clinical guidelines. 22 Although there is some broad guidance for assessment of patient psychosocial factors available, 23 the lack of consensus in surgical practice extends to a range of modalities for addressing patient and family needs with variable potential benefit. In addition to the longstanding practice of informational handouts being provided in clinic, 24 educational written materials and videos explaining surgery and postoperative and nutritional advice are largely available online, such as guidance posted by the British Orthodontic Society.…”

In response: Not all acute normovolemic hemodilutions are created equal

“…5 TXA may be considered as a prophylactic hemostatic intervention in major orthognathic surgery because only 25% of oromaxillary surgeons currently use TXA. 3 FUNDING INFORMATION Not applicable.…”

“…In a recently published survey of orthognathic surgeons, 93% of the respondents replied RBC was transfused rarely (<1%). 3 Second, neither amounts of gelatin administered, nor implication of hemodilution was discussed. Induced hemodilution was not excessive, but relative to the control, treatment group had elevated PT/APTT values during ANH using gelatin.…”