Orthognathic Surgery: A NSQIP-Pediatric Comparison of Peri-Operative Factors and Outcomes Between Patients with and without Cleft Lip/Palate
Victoria G. Zeyl, BA1, Christopher D. Lopez, MD2, Joshua Yoon MD3, Krissia M. Rivera Perla MPH1, Pasha Shakoori MD4, Alisa O. Girard MBS2, Elizabeth Hopkins MD2, Richard Redett MD2, Robin S. Yang, MD, DDS2
1. Division of Plastic Surgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA2. Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA3. Division of Plastic, Reconstructive & Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USA4. Department of Plastic and Reconstructive Surgery University of Southern California, Los Angeles, California, USA
Background: Intervention on cleft lip/palate differences with orthognathic surgery can improve patients' childhood development. However, the differences in preoperative risk and complication profiles for cleft and noncleft patients undergoing orthognathic surgery have not been well described. The present study aimed to comprehensively investigate the risk factors, complication profiles, and clinical outcomes of cleft and noncleft patients undergoing single jaw (bilateral sagittal split osteotomy (BSSO) or LeFort 1) and double jaw (BSSO + LeFort 1) surgery.
Methods: Using the National Surgical Quality Improvement Program database, patients were identified using CPT codes for BSSO and LeFort 1 osteotomy, from years 2018-2019, to conduct a retrospective cross-sectional analysis. Patients under 12 years of age were excluded from the BSSO group. Demographics for double jaw and single jaw groups were collected. Multivariate logistic regression was used to determine the odds of complications and length of stay for cleft and noncleft patients.
Results: A total of 579 patients underwent orthognathic surgery [67.5% (n =391) LF1 only, 15.5% (n=89) BSSO only, and 17% (n =99) bimaxillary LFI/BSSO]. Cleft differences were present in 56% of LFI patients, 10% of BSSO patients, and 20% of bimaxillary patients. A greater proportion of bimaxillary patients (26.3%) had airway structural abnormalities compared to the LF1 (9.2%) and BSSO (12.0%) only groups, (p<0.01 and p=0.02, respectively). ASA classes differed significantly between groups; bimaxillary and BSSO only groups were majority ASA class I and II (bimaxillary, 42.4% and 45.5%; BSSO only, 35.0% and 53.0%, respectively), while the majority of the LF1 group was class II and III ( 57.9% and 16.2%, p<0.01). Among all groups, superficial incisional surgical site infection (SSI) occurred in 3 patients. In terms of medical complications, 9 LFI patients (2.3%), required transfusion, followed by 2 patients in the BSSO group (2%) and 1 patient (1%) in the LFI/BSSO group. After multivariate adjustment, ASA class III was a significant predictor of overall complications with 354% increased odds of any complication (OR=4.54; CI [1.61-12.84], p<0.01) and 62% increased LOS (β-coefficient = 1.62, CI=[1.35- 1.94], p<0.01). Presence of cleft was not significantly associated with odds of any complication (p=0.69) nor increased LOS (p=0.46) in this population.
Conclusion: Interestingly, the most significant predictor of complications in pediatric orthognathic surgery was not presence of cleft but rather increased ASA class. Though common in patients seeking orthognathic surgery, cleft differences did not cause additional risk after adjustment for other factors.
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