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Open AccessArticle

Comparison of Orthognathic Surgery Outcomes Between Patients With and Without Underlying High-Risk Conditions: A Multidisciplinary Team-Based Approach and Practical Guidelines

1
Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan
2
Department of Anesthesia, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
3
Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
4
Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan, Chang Gung University, Taoyuan 333, Taiwan
5
Division of Rheumatology, Allergy, and Immunology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
*
Author to whom correspondence should be addressed.
Pang-Yun Chou and Rafael Denadai contributed equally in this study.
J. Clin. Med. 2019, 8(11), 1760; https://doi.org/10.3390/jcm8111760
Received: 30 September 2019 / Revised: 16 October 2019 / Accepted: 22 October 2019 / Published: 23 October 2019
(This article belongs to the Section Stomatology)
Orthognathic surgery (OGS) has been successfully adopted for managing a wide spectrum of skeletofacial deformities, but patients with underlying conditions have not been treated using OGS because of the relatively high risk of surgical anesthetic procedure-related complications. This study compared the OGS outcomes of patients with and without underlying high-risk conditions, which were managed using a comprehensive, multidisciplinary team-based OGS approach with condition-specific practical perioperative care guidelines. Data of surgical anesthetic outcomes (intraoperative blood loss, operative duration, need for prolonged intubation, reintubation, admission to an intensive care unit, length of hospital stay, and complications), facial esthetic outcomes (professional panel assessment), and patient-reported outcomes (FACE-Q social function, psychological well-being, and satisfaction with decision scales) of consecutive patients with underlying high-risk conditions (n = 30) treated between 2004 and 2017 were retrospectively collected. Patients without these underlying conditions (n = 30) treated during the same period were randomly selected for comparison. FACE-Q reports of 50 ethnicity-, sex-, and age-matched healthy individuals were obtained. The OGS-treated patients with and without underlying high-risk conditions differed significantly in their American Society of Anesthesiologists Physical Status (ASA-PS) classification (p < 0.05), Charlson comorbidity scores, and Elixhauser comorbidity scores. The two groups presented similar outcomes (all p > 0.05) for all assessed outcome parameters, except for intraoperative blood loss (p < 0.001; 974.3 ± 592.7 mL vs. 657.6 ± 355.0 mL). Comparisons with healthy individuals revealed no significant differences (p > 0.05). The patients with underlying high-risk conditions treated using a multidisciplinary team-based OGS approach and the patients without the conditions had similar OGS-related outcomes. View Full-Text
Keywords: orthognathic surgery; underlying conditions; safety; perioperative care; multidisciplinary care; guidelines orthognathic surgery; underlying conditions; safety; perioperative care; multidisciplinary care; guidelines
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Chou, P.-Y.; Denadai, R.; Chen, C.; Pai, B. .-J.; Hsu, K.-H.; Chang, C.-T.; Pascasio, D.; Lin, J. .-J.; Chen, Y.-R.; Lo, L.-J. Comparison of Orthognathic Surgery Outcomes Between Patients With and Without Underlying High-Risk Conditions: A Multidisciplinary Team-Based Approach and Practical Guidelines. J. Clin. Med. 2019, 8, 1760.

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