title: Impact of third molar removal on demands for postoperative care and job disruption: does anaesthetic choice make a difference?
abstract: A prospective cohort study was undertaken to investigate the influences of anaesthetic modality and surgical difficulty on social reintegration and demands on health services after third molar removal. The study was undertaken at the Oral and Maxillofacial Surgery Department, Cardiff Dental Hospital. Of 444 patients, 266 (60%) had their third molars removed. The main outcome measures included anaesthetic modality, surgical difficulty (WHARFE scores), utilisation of health services, effects on work, school and home life. In all, 101 (40%) patients were treated under local anaesthesia (LA) +/- intravenous (i.v.) sedation and 165 (60%) under general anaesthesia (GA); 81 (49%) as inpatients and 84 (51%) as day cases. Of these patients, 38 (14%) returned to the hospital and 74 (28%) utilised primary care services postoperatively in addition to a standard review appointment. Patients treated under GA made more demands on primary care services (chi 2 = 6.41, df = 2, P < 0.05) and took more time away from work (P < 0.05). Patients underestimated the time they needed to recover. There was similar disruption to job, college and home life. There were no links between disruption and particular anaesthetic modalities and surgical difficulty. Surgery under GA was linked to increased postoperative demands on primary care, but not secondary care, and to longer job disruption. This could not fully be attributed to surgical difficulty.
authors.affiliation: Department of Oral Surgery, Medicine and Pathology, University of Wales College of Medicine, Dental School, Cardiff.
authors.forename: D J
authors.initials: DJ
authors.lastname: Edwards
authors.forename: J
authors.initials: J
authors.lastname: Horton
authors.forename: J P
authors.initials: JP
authors.lastname: Shepherd
authors.forename: M R
authors.initials: MR
authors.lastname: Brickley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000766:Anesthesia, Dental; D000768:Anesthesia, General; D000772:Anesthesia, Local; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D008964:Molar, Third; D010342:Patient Acceptance of Health Care; D011183:Postoperative Complications; D011446:Prospective Studies; D013997:Time Factors; D014081:Tooth Extraction / Q000009:adverse effects*; D016896:Treatment Outcome