Resident, Oral & Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA.
Associate Professor, Oral & Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA.
J Oral Maxillofac Surg. 2022 Jun;80(6):996-1006. doi: 10.1016/j.joms.2022.01.018. Epub 2022 Feb 2.
The incidence of older patients undergoing orthognathic surgery is increasing. The purpose of this study is to evaluate the association between age and perioperative adverse outcomes in patients undergoing orthognathic surgery.
This is a retrospective cohort study of patients undergoing orthognathic surgery in the 2011 to 2019 American College of Surgeons National Surgical Quality Improvement Program databases. The primary predictor variable was age group (≥40 or <40 years). The primary outcome variable was adverse outcomes occurring within 30 days of the index operation. Descriptive, bivariate, and Firth logistic regression statistics were utilized to evaluate association between age and adverse outcomes.
During the study period, 1,226 patients underwent an orthognathic procedure and 835 subjects were included. Of these subjects, 145 were 40 years or older (17.4%) and 690 were less than 40 years (82.6%). Subjects 40 years or older were more likely to be American Society of Anesthesiologists (ASA) classification II (P ≤ .001), ASA III (P ≤ .001), or diagnosed with obstructive sleep apnea (P ≤ .001). A total of 34 subjects experienced an adverse outcome (4.07%), though there was no significant difference in the incidence of adverse outcomes between age groups (P = .152). In bivariate analysis, hypertension on medication (P = .037), procedure type (P = .001), and segmented Le Fort I osteotomies (P = .039) were associated with adverse outcomes. After controlling for age, hypertension on medication, segmented Le Fort I osteotomies, and diagnosis of obstructive sleep apnea, isolated mandibular osteotomies were the only independent predictors of adverse outcomes (odds ratio 2.64; 95% confidence interval, 1.06 to 7.24; P = .038). Length of stay was 1.38 ± 1.43 days for the 40 years or older group compared to 1.06 ± 1.18 in the <40 group (P = .012).
Despite higher ASA classifications, older patients did not have a significantly greater incidence of perioperative adverse outcomes including airway complications, nor was increased age associated with adverse outcomes in bivariate or multivariate analysis.
接受正颌手术的老年患者的发病率正在增加。本研究的目的是评估年龄与正颌手术患者围手术期不良结局之间的关系。
这是一项回顾性队列研究，纳入了 2011 年至 2019 年美国外科医师学会国家手术质量改进计划数据库中接受正颌手术的患者。主要预测变量为年龄组（≥40 岁或<40 岁）。主要结局变量为指数手术后 30 天内发生的不良结局。采用描述性、双变量和 Firth 逻辑回归统计方法评估年龄与不良结局之间的关系。
在研究期间，1226 例患者接受了正颌手术，其中 835 例患者被纳入研究。在这些患者中，145 例患者年龄为 40 岁或以上（17.4%），690 例患者年龄小于 40 岁（82.6%）。40 岁及以上的患者更有可能是美国麻醉医师协会（ASA）分类 II（P≤0.001）、ASA III（P≤0.001）或诊断为阻塞性睡眠呼吸暂停（P≤0.001）。共有 34 例患者发生不良结局（4.07%），但两组不良结局发生率无显著差异（P=0.152）。在双变量分析中，药物治疗的高血压（P=0.037）、手术类型（P=0.001）和分段 Le Fort I 截骨术（P=0.039）与不良结局相关。在控制年龄、药物治疗的高血压、分段 Le Fort I 截骨术和阻塞性睡眠呼吸暂停诊断后，单纯下颌骨截骨术是唯一与不良结局相关的独立预测因素（比值比 2.64；95%置信区间，1.06 至 7.24；P=0.038）。40 岁及以上组的住院时间为 1.38±1.43 天，<40 岁组为 1.06±1.18 天（P=0.012）。
尽管 40 岁及以上患者的 ASA 分级较高，但与围手术期不良结局（包括气道并发症）的发生率并无显著差异，且在双变量或多变量分析中，年龄增加与不良结局无关。
