Orthognathic Surgery Risk Factors and Complications in Patients with Increasing Age

Orthognathic Surgery Risk Factors and Complications in Patients with Increasing Age

Alexis Irby (D’17), Allan Wun¹ DMD, Matthew Finkelman² PhD, Maria Papageorge¹ DMD, MS, Archana Viswanath¹BDS, MS

¹Department of Oral and Maxillofacial Surgery, ²Tufts University School of Dental Medicine

Background: The average patient receiving orthognathic surgery is usually in their second or third decade of life. Over the past decade there has been a significant increase in the number of patients seeking orthognathic surgery including those over the age of 40. With this increase in the older population (>40 yr. old) this retrospective study sought to identify perioperative and postoperative difficulties that are significantly different for patients with increasing age; evaluating age as a continuum. Surgeons benefit from an increased knowledge for this cohort of patients and furthermore will have more information to better manage patient care pre-, intra- and postoperatively.

Methods: This retrospective cohort study of patients was conducted in the Department of Oral Surgery at Tufts University School of Dental Medicine. Following IRB approval, we reviewed medical records of all patients who underwent orthognathic surgery in the past ten years (4/1/2005-4/1/2015). The dependent variables were amount of blood loss, the necessity for blood transfusions, length of hospital stay and intraoperative complications and the independent variables were age, gender, race, BMI, medical history, type of orthognathic surgery, and duration of the surgery. Descriptive statistics were computed for all variables. Associations between variables were assessed via the Spearman correlation. P-values less than 0.05 were considered statistically significant. SPSS version 22 was used in the analysis.

Results: This retrospective chart review included 230 patient charts. The average length of hospital stay for patients >40 yr. old was higher than <40 yr. old (64.55 hours vs 51.67 hours, respectively). Patients >40 yr. old lost more blood, in liters, compared to <40 yr. old (.212 vs .175, respectively). Greater complications were experienced by <40 yr. old group due to various mandibular fracture while those >40 yr. old experienced more complications related to excessive bleeding. Association between blood loss and age: n = 108. Spearman correlation = 0.264. p = 0.006. Association between length of stay and age: n = 93. Spearman correlation = 0.214. p = 0.039.

Conclusion: The findings from this retrospective chart review of patients undergoing orthognathic surgery indicate that:

1. There is a significant increase in intraoperative complications and the necessity for postsurgical supportive care following surgery for patients over the age of 40.
2. There was an increased incidence of intraoperative mandibular fracture in patients under the age of 25.
3. Comorbidities including increased BMI and increased incidence of disease states contribute to intraoperative complications irrespective of age.

Retrospective chart review is an essential methodology, which has the potential to provide oral surgery with valuable research opportunities. It is imperative that further studies with larger core groups be conducted to expand upon this foundation and provide better supportive care for patients as they increase in age.

References

1. Peacock, Lee CC, Kline KP: Orthognathic surgery in patients over 40 years of age: Indications and Special Considerations. The International Journal of Adult Orthodontics and Orthognathic Surgery. U.S. National Library of Medicine, Oct 2014. Web. 20 Apr. 2015.
2. Phillips, Hillary L. Broder HL, Bennett ME: Dentofacial disharmony: Motivations for seeking treatment. The International Journal of Adult Orthodontics and Orthognathic Surgery. U.S. National Library of Medicine, 06 May 2013. Web. 20 Apr. 2015.