Objective
The purpose of our study was to analyze what factors influence the cost of orthognathic
surgery performed within the US.
Study Design
This retrospective cohort study was completed using the Kids’ Inpatient Database (KID)
from 2000 to 2012 on all patients aged 14 to 20 years who had undergone orthognathic
surgery. The predictor variables included patient and hospitalization characteristics.
The primary outcome variable was hospital charge ($). Multivariate linear regression
was conducted to determine independent predictors for increased/decreased hospital
charge.
Results
The final sample consisted of 14 191 patients (mean age, 17.4 ± 1.6 years; females,
59.2%). Each additional day in the hospital added $8123 in hospital charges (P < .01). Relative to mandibular osteotomy, maxillary osteotomy (+$5703, P < .01) and bimaxillary osteotomy (+$9419, P < .01) were each associated with increased hospital charges. Genioplasty (+$3499,
P < .01), transfusion of packed cells (TPC) (+$11 719, P < .01), continuous invasive mechanical ventilation (CIMV) <96 hours (+$23 502, P < .01), and CIMV ≥96 hours (+$30 901, P < .01) were each associated with significantly increased hospital charges. Obstructive
sleep apnea (OSA) added $6560 in hospital charges (P < .01).
Conclusions
Maxillary osteotomy and bimaxillary surgery were each associated with significantly
increased charges relative to mandibular osteotomy. Concomitant genioplasty, TPC,
CIMV, and OSA each significantly increased the charges. Each additional day to the
length of stay significantly increased the charges.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Oral Surgery, Oral Medicine, Oral Pathology and Oral RadiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- Simultaneous rhinoseptoplasty and orthognathic surgery: outcome analysis of 250 consecutive patients using a modified Le Fort I osteotomy.Aesthetic Plast Surg. 2018; 42: 1090-1100
- Surgical site infections following bimaxillary orthognathic, osseous genioplasty, and intranasal surgery: a retrospective cohort study.J Oral Maxillofac Surg. 2017; 75: 584-595
- Cosmetic procedures in orthognathic surgery.J Oral Maxillofac Surg. 2011; 69: 716-723
- Operative time, airway management, need for blood transfusions, and in-hospital stay for bimaxillary, intranasal, and osseous genioplasty surgery: current clinical practices.J Oral Maxillofac Surg. 2016; 74: 590-600
- Simultaneous orthognathic surgery with Asian double eyelid suture blepharoplasty.J Craniofac Surg. 2021; 32: 2592-2596
- The clinical relevance of orthognathic surgery on quality of life.Int J Oral Maxillofac Surg. 2011; 40: 926-930
- Patient responses to the orthognathic surgical experience: factors leading to dissatisfaction.J Oral Maxillofac Surg. 1983; 41: 770-774
- Patients’ perception of improvement after orthognathic surgery: pilot study.Br J Oral Maxillofac Surg. 2006; 44: 24-27
- Orthognathic surgery has a significant positive effect on perceived personality traits and perceived emotional expressions in long face patients.J Oral Maxillofac Surg. 2019; 77 (408e.1-408e10)
- Multicentre study of operating time and inpatient stay for orthognathic surgery.Br J Oral Maxillofac Surg. 2010; 48: 360-363
- Impact of intraoperative fluid administration on length of postoperative hospital stay following orthognathic surgery.J Oral Maxillofac Surg. 2015; 73: 22-29
- Presurgical planning and time efficiency in orthognathic surgery: the use of computer-assisted surgical simulation.Plast Reconstr Surg. 2011; 128: 179e-181e
- Virtual planning in orthognathic surgery.Int J Oral Maxillofac Surg. 2014; 43: 957-965
- Community hospital charges for orthognathic surgery.Int J Adult Orthodon Orthognath Surg. 1996; 11: 253-255
- The impact of clinical practice patterns on hospital charges for orthognathic surgery.Int J Adult Orthodon Orthognath Surg. 1994; 9: 251-256
- Orthognathic cases: what are the surgical costs?.Eur J Orthod. 2008; 30: 31-39
- Safe, efficient, and cost-effective orthognathic surgery in the outpatient setting.J Oral Maxillofac Surg. 2009; 67: 2064-2071
- Changing patterns of hospital length of stay after orthognathic surgery.J Oral Maxillofac Surg. 2008; 66: 492-497
- Operative time, length of stay and reoperation rates for orthognathic surgery.Br J Oral Maxillofac Surg. 2021; 59: 163-167
- Major complications and 30-day morbidity for single jaw versus bimaxillary orthognathic surgery as reported by NSQIP.Cleft Palate Craniofac J. 2019; 56: 705-710
- Cost comparison of genioplasty: when indicated, wire osteosynthesis is more cost effective than plate and screw fixation.Oral Maxillofac Surg. 2014; 18: 439-444
- Invasive mechanical ventilation.South Med J. 2018; 111: 746-753
- Utilization strategies for intensive care units.JAMA. 1989; 261: 2389-2395
- An update on cost-effectiveness analysis in critical care.Curr Opin Crit Care. 2002; 8: 337-343
- Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study.JAMA. 2002; 287: 345-355
- Daily cost of an intensive care unit day: the contribution of mechanical ventilation.Crit Care Med. 2005; 33: 1266-1271
- Orthognathic surgery patients (maxillary impaction and setback plus mandibular advancement plus genioplasty) need more intensive care unit (ICU) admission after surgery.J Dent (Shiraz). 2015; 16: 43-49
- Is intensive care unit monitoring necessary after maxillomandibular advancement for management of obstructive sleep apnea?.J Oral Maxillofac Surg. 2022; 80: 456-464
- Orthognathic surgery in the management of obstructive sleep apnoea: experience from maxillofacial surgery unit in the United Kingdom.Br J Oral Maxillofac Surg. 2014; 52: 496-500
- Maxillomandibular advancement versus multilevel surgery for treatment of obstructive sleep apnea: a systematic review and meta-analysis.Sleep Med Rev. 2021; 57101471
- Volumetric analysis of the pharynx in patients with obstructive sleep apnea (OSA) treated with maxillomandibular advancement (MMA).Sleep Breath. 2013; 17: 395-401
- Maxillomandibular advancement for the treatment of obstructive sleep apnea: a systematic review and meta-analysis.Sleep Med Rev. 2010; 14: 287-297
- Orthognathic surgery for obstructive sleep apnea. 2019; 25: 218-229
- Prevalence of postoperative complications after orthognathic surgery: a 15-year review.J Oral Maxillofac Surg. 2007; 65: 984-992
- Process mapping and Lean principles applied to orthognathic surgery.Br J Oral Maxillofac Surg. 2021; 59: 157-162
- Relative blood loss and operative time can predict length of stay following orthognathic surgery.Int J Oral Maxillofac Surg. 2016; 45: 1209-1212
- 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
- Risk factors for prolonged mechanical ventilation and delayed extubation following bimaxillary orthognathic surgery: a single-center retrospective cohort study.J Clin Med. 2022; 11: 3829
Article info
Publication history
Published online: November 16, 2022
Accepted:
November 8,
2022
Received in revised form:
November 4,
2022
Received:
October 1,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
