A national review of mandibular orthognathic surgery activity in the National Health Service in England over a nine year period: part 1--service factors.

We aimed to investigate the changing provision of mandibular orthognathic surgery in England for the period 1 April 1997-30 March 2006. Data on hospital inpatient activity were extracted from the NHS Hospital Episode Statistics (HES) database for all mandibular orthognathic surgical procedures between these dates. We investigated provider factors (in which units providing services were classified as undertaking either high or low volumes of activity) and temporal changes. There was a steady increase in the number of procedures over time, and a decrease in the mean time spent in hospital (p<0.001). Provider units with high volumes of activity had shorter inpatient stays than those that provided low volume (p<0.001) and exhibited a greater reduction in the duration of inpatient stays (p=0.02). Patterns of care are changing, and increasing numbers of treatments are being done as day-cases (p<0.001). Units with high volumes seem to be more efficient in terms of duration of hospital stay than low volume units. However, our data do not allow an insight into the quality of care provided, and further research is needed to address this issue.