Is Same-Day Discharge Safe for Outpatient Orthognathic Surgery? – A research Protocol
Ahmad M. AlAli1, Amal Idrissi Janati1,2, Jesse Ibanez2, Jordan Gigliotti1,2
1 Department of Oral and Maxillofacial Surgery, McGill University Health Centre, Montreal, Québec, Canada 2 Faculty of Dentistry, McGill University, Montreal, Québec, Canada
Background: Orthognathic surgery is one of the most common procedures that is performed regularly by Oral and Maxillofacial Surgeons worldwide. Historically, this procedure necessitated extended hospital stays; most orthognathic surgery patients are discharged one to two days after surgery. However, recent advancements in surgical and anesthetic techniques have led to the development of outpatient orthognathic surgery, enabling patients to undergo surgical correction of their dentofacial deformity while minimizing hospital length-of-stay (LOS) and associated costs. Outpatient orthognathic surgery with a same-day discharge approach (no overnight stay) was implemented for a specific group of patients by the Oral and Maxillofacial Surgery (OMFS) Department at McGill University Health Center (MUHC) since the adoption of COVID-19 policies. The purpose of this study is to investigate patient safety when performing orthognathic surgery in outpatient versus inpatient settings. This will further guide us to enhance the OMFS pathway and criteria for the surgical short-stay unit with the Enhanced Recovery After Surgery (ERAS) protocol.
Methods: Retrospective cohort study by reviewing the medical records of MUHC OMFS patients who underwent orthognathic surgery between July 1, 2019, to July 31, 2023, to compare outpatient surgeries (same-day discharge/no overnight stay) and inpatient surgeries (admission/ overnight stay). The extracted data are medical status, diagnosis and surgical plan, perioperative data, hospital length of stay, intraoperative complications and postoperative complications that required emergency department visit or hospitalization within the following 30 days. Inpatient participants will be age and sex frequency-matched to participants in the outpatient group.
Results: Statistical analysis will include descriptive statistics of study participants according to their admission status (outpatient vs. inpatient). Also, multivariable unconditional logistic regression analysis will be performed to estimate the odds ratio quantifying the association between outpatient settings and the occurrence of postoperative complications that required ED visits or hospitalization within 30 days.
Conclusion: This study aims to investigate the perioperative course of orthognathic surgery patients to determine the safety of conducting such procedures in outpatient settings with a same-day discharge approach. This will also help to explore the risk and predictive factors for potential readmissions or postoperative complications. This will further guide us to enhance the OMFS pathway and criteria for the surgical short-stay unit with the Enhanced Recovery After Surgery (ERAS) protocol that aims to speed up functional recovery, reduce the dependence on hospitalization, and reduce the risk of complications without increasing readmissions.