Knoedler Samuel, Baecher Helena, Hoch Cosima C, Obed Doha, Matar Dany Y, Rendenbach Carsten, Kim Bong-Sung, Harhaus Leila, Kauke-Navarro Martin, Hundeshagen Gabriel, Knoedler Leonard, Orgill Dennis P, Panayi Adriana C
Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany.
J Clin Med. 2023 Feb 11;12(4):1444. doi: 10.3390/jcm12041444.
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.
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.
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 ( = 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 ( = 0.03) and readmissions ( = 0.02). In addition, Asian ethnicity was identified as a risk factor for bleeding ( = 0.003) and readmission ( = 0.0009).
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.
正颌外科手术（OS）是一种常用于矫正牙颌面畸形和错牙合的手术。关于正颌外科手术的研究大多局限于单外科医生的经验或单机构报告。因此，我们回顾性分析了一个多机构数据库，以研究正颌外科手术的结果，并确定围手术期和术后并发症的风险因素。
我们回顾了美国外科医师学会国家外科质量改进计划（ACS-NSQIP）数据库（2008 - 2020年），以确定因下颌骨和上颌骨发育不全及过度发育而接受正颌外科手术的患者。感兴趣的术后结果包括30天手术和医疗并发症、再次手术、再次入院和死亡率。我们还评估了并发症的风险因素。
研究人群包括674例患者，其中48%接受单颌手术，40%接受双颌手术，5.5%接受三颌手术。平均年龄为29±11岁，性别分布均衡（女性：n = 336；50%，男性：n = 338；50%）。不良事件相对较少，共报告29例（4.3%）并发症。最常见的手术并发症是浅表切口感染（n = 14；2.1%）。多变量分析显示，单纯单下颌手术（= 0.03）与手术并发症的发生独立相关，同时还确定了门诊手术环境与手术并发症发生率（= 0.03）和再次入院率（= 0.02）之间的关联。此外，亚洲人种被确定为出血（= 0.003）和再次入院（= 0.0009）的风险因素。
基于ACS-NSQIP数据库记录的信息，我们的分析强调了正颌外科手术（短期）的良好安全性。我们发现下颌骨正颌外科手术的并发症发生率较高。正颌外科手术在门诊手术环境中的风险作用值得进一步研究。发现亚洲正颌外科手术患者与术后不良事件之间存在显著相关性。将这些新的风险因素纳入手术流程可能有助于面部外科医生优化患者选择并改善患者预后。未来需要进行研究以调查所观察到的统计相关性的因果关系。
