Orthognathic Surgery: A Comparison of Academic Vs Private Practice

Medical studies have shown that Academic Medical Centers (AMCs) have higher costs of treatment compared with Private Practice or nonteaching entities (PP), and have also consistently treated a higher number of patients with comorbidities with good outcomes. Patient acuity contributes to the higher cost at these centers¹. Orthognathic surgery has revolutionized the field of OMFS, and improvements in treatment with higher success rates has allowed surgeons to migrate to community hospitals from tertiary centers to perform these procedures². This study evaluates patients in Academic vs. Private Practice by diagnosis, ASA level, surgical complexity, indications for surgery, and medical morbidities.

Orthognathic patients' records at UAB AMC department of OMFS from the years 2004-2010 were compared to records of a local OMFS PP group from years 2007-2011. Surgical procedures included Lefort, BSSO, genioplasty, and combinations of these. Charts were scrutinized for age, sex, past medical history, ASA classification, dentofacial deformity, and indications for surgical procedures.

A total of 1,331 patients were operated on by the two groups. This gave a sample size of 333 patients from the UAB AMC and 560 patients for the PP group. A chart review by an experienced clinician was used to gather data. 4 specific comorbidities were analyzed (DM, HTN, OSA, CAD) as well as ASA classification. Indications for procedures were evaluated including post-traumatic deformity correction, TMJ issues, OSA, cleft palate, and dentofacial deformities. The pearson chi-square test was applied to the majority of the comparisons. The fisher's exact test was also used in select cases, both with a p value <0.05 denoting significance.

Results showed that the average age of patients encountered in both groups was similar, with AMC having an average age of 29 and PP at 27. There was a much larger proportion of female patients treated in PP setting (M/F ratio for AMC is 1.06/1, in PP it was 1/1.6) There was a statistical significance in all 3 co-morbidities, with the AMC having a higher percentage in all 3. There was a marked difference in percentage of ASA levels observed for each group, with AMC having a statistically significant higher ASA class 2 and 3 patients compared to PP. There was a statistically significant difference in percentage of procedures performed for TMJ related issues, OSA, post-traumatic deformities, and cleft palate patients, with the higher percentage being performed at AMC. Average time of procedure and length of stay was higher in AMC than PP.

This comparative demographic study suggests that OMFS AMCs tend to treat orthognathic surgical patients with higher numbers of comorbidities and systemic illnesses. This correlates with previous medical and surgical specialty studies¹. It also indicates that OMFS AMCs treat a higher percentage of patients with concurrent medical abnormalities than only patients with dentofacial abnormalities.

1. Lisa I. Iezzoni et. al. Illness Severity and Costs of Admissions at Teaching and Nonteaching Hospitals. JAMA, 1990; 264(11):1426-1431.

2. Carter J, Mohammad A. Accelerated Orthognathic Surgery and Increased Orthodontic Efficiency—A Paradigm Shift: A Special Series Part I Building Nonhospital-Based Platforms for Ambulatory Orthognathic Surgery: Facility, Anesthesia, and Price Considerations. Journal of Oral and Maxillofacial Surgery, 2009;67(10): 2054-2063.