Trends in Orthognathic Surgery: A National Survey of Orthodontists

In the past two decades, studies have identified a decrease in the number of orthognathic procedures performed. Those studies attributed the decline to the significant reduction in reimbursement by insurance providers, increasing healthcare costs, and the difficulty in obtaining insurance coverage for the procedure. In this study, we examine the current orthognathic trends in order to identify if there continues to be a decline in orthognathic cases performed, and if so, the realities driving the decline. 

This cross-sectional study, utilizing the American Academy of Orthodontics Partners in Research Program, collected the opinions of practicing orthodontists regarding orthognathic surgery in their patient populations over the last five years (2009-2013). They were asked if there was a change in the number of active surgical cases in their practices, and if so, what led to that change. They rated various reasons as having a major effect, minor effect or no effect.

Out of 1,300 orthodontists invited to participate, 174 (13%) accepted the informed consent and responded to the electronic survey. The results were descriptively analyzed. The mean number of orthognathic cases completed per orthodontist in the last year was 3.7.  The median percentage of patients that could benefit from orthognathic surgery that were referred to a surgeon to discuss the treatment option was 50-59%.

In the last five years, 40% of orthodontists noted a decrease in the number of active orthognathic cases in their practice. The lack of medical insurance coverage for this procedure (major effect: 82%, minor effect: 6%) and increased out of pocket expenses for the patients (major effect: 76%, minor effect: 8%) were the most profound causes for this decline. Other factors that were noted include decreased patient acceptance of a surgical treatment plan (major effect: 33%, minor effect: 52%), advances in orthodontic techniques, i.e. TADs, accelerated osteogenic orthodontics, etc. (major effect: 16%, minor effect: 56%) and inability to find a surgeon to perform the operation (major effect: 3%, minor effect: 26%).

In the last five years, 12% of orthodontists noted an increase in the number of active orthognathic cases in their practice. This increase was attributed to increased patient acceptance for a surgical treatment plan (major effect: 59%, minor effect: 35%). Other factors that were noted include increased number of patients who would benefit from the treatment (major effect: 41%, minor effect: 41%), increased comfort with surgical treatment planning (major effect: 35%, minor effect: 35%), and a new surgeon they enjoy working with (major effect: 35%, minor effect: 23%).

In regards to surgeon availability, 69% of orthodontists have not had difficulty retaining a surgeon to perform their orthognathic surgeries. Of those who have had difficulty retaining a surgeon, 16% report that it is due to the lack of surgeon willingness to perform the operation—in fact, 54% of respondents have had a surgeon decline an orthognathic case, in the past five years, due to poor insurance reimbursement for the procedure.

In conclusion, this suggests that the continued decline in the number of patients undergoing surgical correction of their skeletal discrepancies is directly related to medical insurance and reimbursement, as well as other factors that have not been previously discussed. 

References:

1. Zins JE, Bruno J, Moreira-Gonzales A, et al. Orthognathic Surgery: Is There a Future? Plast Reconstr Surg 115:1442,2005

2. Farrell, Brian, Tucker, Myron. Safe, Efficient, and Cost-Effective Orthoghanthic Surgery in the Outpatient Setting. Journal of Oral and Maxillofacial Surgery Volume 67, Issue 10. Oct. 2009.