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Ambulatory sagittal split ramus osteotomy: strategy for enhanced recovery after surgery

  • Y. Hattori
    Affiliations
    Department of Plastic Surgery, Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, Setagaya-ku, Tokyo, Japan
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  • H. Uda
    Correspondence
    Correspondence to: Department of Plastic Surgery, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke, Tochigi 329–0498, Japan. Tel: +81 285 58 8940. Fax: +81 285 40 8280.
    Affiliations
    Department of Plastic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan

    Lilla Craniofacial Clinic Tokyo, Chuo-ku, Tokyo, Japan
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  • A. Niu
    Affiliations
    Department of Plastic Surgery, Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, Setagaya-ku, Tokyo, Japan
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  • K. Yoshimura
    Affiliations
    Department of Plastic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
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  • Y. Sugawara
    Affiliations
    Department of Plastic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan

    Lilla Craniofacial Clinic Tokyo, Chuo-ku, Tokyo, Japan
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Published:September 10, 2022DOI:https://doi.org/10.1016/j.ijom.2022.08.015

      Abstract

      The sagittal split ramus osteotomy (SSRO) has been performed mainly on an inpatient basis because of the duration of anaesthesia and the potential risk of postoperative complications, such as bleeding, pain, nausea, and vomiting. However, advances in both surgical and anaesthetic management have enabled the reduction of these risks and shortened the length of hospital stay. Thus, the SSRO may be feasible even in the ambulatory setting in elective cases. The clinical records of all patients who underwent an outpatient SSRO between August 2011 and September 2020 at Lilla Craniofacial Clinic were reviewed retrospectively. Data on age, sex, duration of surgery, operative procedures, intraoperative bleeding, and admission status were investigated. In total, 143 patients underwent a bilateral SSRO. The SSRO was performed as an isolated procedure in 73 patients and concomitantly with other surgical procedures in the remaining 70 patients. Overall, 142 of the 143 patients were discharged on the day of surgery (99.3%); only one (0.7%) required an overnight stay because of a submental haemorrhage after genioplasty. No emergency hospitalizations or readmissions occurred after discharge. Multimodal perioperative management, both surgical and anaesthetic, facilitated enhanced patient recovery after surgery, and SSRO was performed successfully and safely as an ambulatory procedure.

      Keywords

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      References

        • Stratton M.
        • Waite P.D.
        • Powell K.K.
        • Scopel M.M.
        • Kukreja P.
        Benefits of the enhanced recovery after surgery pathway for orthognathic surgery.
        Int J Oral Maxillofac Surg. 2022; 51: 214-218
        • Ji Y.D.
        • Dodson T.B.
        Enhanced recovery after surgery pathways in oral and maxillofacial surgery.
        J Oral Maxillofac Surg. 2021; 79: 2380-2381
        • Huamán E.T.
        • Juvet L.M.
        • Nastri A.
        • Denman W.T.
        • Kaban L.B.
        • Dodson T.B.
        Changing patterns of hospital length of stay after orthognathic surgery.
        J Oral Maxillofac Surg. 2008; 66: 492-497
        • Farrell B.B.
        • Tucker M.R.
        Orthognathic surgery in the office setting.
        Oral Maxillofac Surg Clin N Am. 2014; 26: 611-620
        • Davies L.A.
        • Crawford E.M.S.
        • Jones J.L.
        • Jones S.D.
        Day-case bilateral sagittal split osteotomy.
        Br J Oral Maxillofac Surg. 2018; 56: 968-971
        • Farrell B.B.
        • Tucker M.R.
        Safe, efficient, and cost-effective orthognathic surgery in the outpatient setting.
        J Oral Maxillofac Surg. 2009; 67: 2064-2071
        • Knoff S.B.
        • Van Sickels J.E.
        • Holmgreen W.C.
        Outpatient orthognathic surgery: criteria and a review of cases.
        J Oral Maxillofac Surg. 1991; 49: 117-120
        • Blakey G.H.
        • White R.P.
        Bilateral sagittal split osteotomies in an ambulatory care setting.
        Semin Orthod. 1999; 5: 241-243
        • Mock D.R.
        • Davies L.A.
        • Jones S.D.
        Review of patient experience with bilateral sagittal split osteotomies as a day case procedure.
        Br J Oral Maxillofac Surg. 2021; 59: 1056-1060
        • Lupori J.P.
        • Van Sickels J.E.
        • Holmgreen W.C.
        Outpatient orthognathic surgery: review of 205 cases.
        J Oral Maxillofac Surg. 1997; 55: 558-563
        • Carter J.B.
        • Mohammad A.E.
        Building nonhospital-based platforms for ambulatory orthognathic surgery: facility, anesthesia, and price considerations.
        J Oral Maxillofac Surg. 2009; 67: 2054-2063
        • Cangemi C.F.
        Administration of general anesthesia for outpatient orthognathic surgical procedures.
        J Oral Maxillofac Surg. 2011; 69: 798-807
        • Phillips C.
        • Brookes C.D.
        • Rich J.
        • Arbon J.
        • Turvey T.A.
        Postoperative nausea and vomiting following orthognathic surgery.
        Int J Oral Maxillofac Surg. 2015; 44: 745-751
        • Laskin D.M.
        • Carrico C.K.
        • Wood J.
        Predicting postoperative nausea and vomiting in patients undergoing oral and maxillofacial surgery.
        Int J Oral Maxillofac Surg. 2020; 49: 22-27
        • Apfel C.C.
        • Läärä E.
        • Koivuranta M.
        • Greim C.A.
        • Roewer N.
        A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers.
        Anesthesiology. 1999; 91: 693-700
        • Silva A.C.
        • O’Ryan F.
        • Poor D.B.
        Postoperative nausea and vomiting (PONV) after orthognathic surgery: a retrospective study and literature review.
        J Oral Maxillofac Surg. 2006; 64: 1385-1397
        • Bravo M.
        • Bendersky Kohan J.
        • Uribe Monasterio M.
        Effectiveness of glucocorticoids in orthognathic surgery: an overview of systematic reviews.
        Br J Oral Maxillofac Surg. 2022; 60: e231-e245
        • Powell K.
        • Amin D.
        • Sesanto R.
        • Bryant A.
        • Kukreja P.
        • Waite P.
        Do oropharyngeal throat packs prevent fluid ingestion during orthognathic surgery?.
        Int J Oral Maxillofac Surg. 2022; 51: 366-370
        • Schmitt A.R.M.
        • Ritto F.G.
        • de Azevedo J.G.R.L.
        • Medeiros P.J.D.
        • de Mesquita M.C.M.
        Efficacy of gastric aspiration in reducing postoperative nausea and vomiting after orthognathic surgery: a double-blind prospective study.
        J Oral Maxillofac Surg. 2017; 75: 701-708
        • Lin S.
        • Chen C.
        • Yao C.F.
        • Chen Y.A.
        • Chen Y.R.
        Comparison of different hypotensive anaesthesia techniques in orthognathic surgery with regard to intraoperative blood loss, quality of the surgical field, and postoperative nausea and vomiting.
        Int J Oral Maxillofac Surg. 2016; 45: 1526-1530
        • Zhao H.
        • Liu S.
        • Wu Z.
        • Zhao H.
        • Ma C.
        Comprehensive assessment of tranexamic acid during orthognathic surgery: a systematic review and meta-analysis of randomized, controlled trials.
        J Craniomaxillofac Surg. 2019; 47: 592-601
        • Lin S.
        • McKenna S.J.
        • Yao C.F.
        • Chen Y.R.
        • Chen C.
        Effects of hypotensive anesthesia on reducing intraoperative blood loss, duration of operation, and quality of surgical field during orthognathic surgery: a systematic review and meta-analysis of randomized controlled trials.
        J Oral Maxillofac Surg. 2017; 75: 73-86
        • Olsen J.J.
        • Skov J.
        • Ingerslev J.
        • Thorn J.J.
        • Pinholt E.M.
        Prevention of bleeding in orthognathic surgery—a systematic review and meta-analysis of randomized controlled trials.
        J Oral Maxillofac Surg. 2016; 74: 139-150
        • Mommaerts M.Y.
        Endoscopically assisted sagittal split osteotomy for mandibular lengthening: technical note and initial experience.
        J Craniomaxillofac Surg. 2010; 38: 108-112
        • Sakuragi T.
        • Ohma H.
        • Ohteki H.
        Efficacy of SOFT COAG for intraoperative bleeding in thoracic surgery.
        Interact Cardiovasc Thorac Surg. 2009; 9: 767-768
        • Sakuragi T.
        • Okazaki Y.
        • Mitsuoka M.
        • Itoh T.
        Dramatic hemostasis of the transected pulmonary artery model using SOFT COAG electrosurgical output.
        Interact Cardiovasc Thorac Surg. 2008; 7: 764-766
        • Chung F.
        • Chan V.W.
        • Ong D.
        A post-anesthetic discharge scoring system for home readiness after ambulatory surgery.
        J Clin Anesth. 1995; 7: 500-506
        • Politis C.
        Life-threatening haemorrhage after 750 Le Fort I osteotomies and 376 SARPE procedures.
        Int J Oral Maxillofac Surg. 2012; 41: 702-708
        • Ferrara J.T.
        • Tehrany G.M.
        • Chen Q.
        • Sheinbaum J.
        • Mora-Marquez J.
        • Hernandez Conte A.
        • Rudikoff A.G.
        Evaluation of an enhanced recovery after surgery protocol (ERAS) for same-day discharge and reduction of opioid use following bimaxillary orthognathic surgery.
        J Oral Maxillofac Surg. 2022; 80: 38-46