title: Impact of Perioperative Fluid Administration on Postoperative Morbidity and Length of Hospital Stay Following Maxillomandibular Advancement for Obstructive Sleep Apnea.
abstract: OBJECTIVE
  The purpose of this study was to evaluate whether the volume of perioperative fluids administered to patients undergoing maxillomandibular advancement (MMA) for treatment of obstructive sleep apnea (OSA) is associated with an increased incidence of postoperative complications and prolonged length of hospital stay.
  
  
  METHODS
  A retrospective cohort study design was implemented and patients undergoing MMA for OSA at the Mayo Clinic were identified from 2001 through 2014. The primary predictor variable was the total volume of intravenous fluids administered during MMA. The primary outcome variable was length of hospital stay in hours. Secondary outcome variables included the presence of complications incurred during postoperative hospitalization. Additional covariates abstracted included basic demographic data, preoperative body mass index, preoperative apnea-hypopnea index, preoperative Charlson comorbidity index, preoperative American Society of Anesthesiologists score, type of intravenous fluid administered, surgical complexity score, duration of anesthesia, duration of surgery, and the use of planned intensive care unit admission. Univariate and multivariable models were developed to assess associations between the primary predictor variable and covariates relative to the primary and secondary outcome variables.
  
  
  RESULTS
  Eighty-eight patients undergoing MMA for OSA were identified. Total fluid volume was significantly associated with increased length of stay (odds ratio [OR] = 1.34, 95% confidence interval [CI], 1.05-1.71; P = .020) in univariate analysis. Total fluid volume did not remain significantly associated with increased length of hospital stay in stepwise multivariable modeling. Total fluid volume was significantly associated with the presence of postoperative complications (OR = 1.69; 95% CI, 1.08-2.63; P = .021) in univariate logistic regression.
  
  
  CONCLUSIONS
  Fluid administration was not found to be significantly associated with increased length of hospital stay after MMA for OSA. Increased fluid administration might be associated with the presence of postoperative complications after MMA; however, future large multicenter studies will be required to more comprehensively assess this association.
authors.affiliation: Resident, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN. Electronic address: ettinger.kyle@mayo.edu.
authors.forename: Kyle S
authors.initials: KS
authors.lastname: Ettinger
authors.affiliation: Medical Student, Mayo Clinic and Mayo College of Medicine, Rochester, MN.
authors.forename: Cody C
authors.initials: CC
authors.lastname: Wyles
authors.affiliation: Resident, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN.
authors.forename: Brett J
authors.initials: BJ
authors.lastname: Bezak
authors.affiliation: Resident, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN.
authors.forename: Yavuz
authors.initials: Y
authors.lastname: Yildirim
authors.affiliation: Assistant Professor of Surgery and Program Director, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN.
authors.forename: Kevin
authors.initials: K
authors.lastname: Arce
authors.affiliation: Assistant Professor of Surgery and Program Chair, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN.
authors.forename: Christopher F
authors.initials: CF
authors.lastname: Viozzi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000766:Anesthesia, Dental / Q000706:statistics & numerical data; D000768:Anesthesia, General / Q000706:statistics & numerical data; D015992:Body Mass Index; D015331:Cohort Studies; D003422:Critical Care / Q000706:statistics & numerical data; D000077324:Crystalloid Solutions; D005260:Female; D005440:Fluid Therapy / Q000706:statistics & numerical data*; D005500:Follow-Up Studies; D063172:Genioplasty / Q000379:methods; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007552:Isotonic Solutions / Q000627:therapeutic use; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D019186:Mandibular Advancement / Q000379:methods*; D063166:Maxillary Osteotomy / Q000379:methods*; D008875:Middle Aged; D061646:Operative Time; D019340:Osteotomy, Le Fort / Q000379:methods; D059229:Osteotomy, Sagittal Split Ramus / Q000379:methods; D011183:Postoperative Complications; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000145:classification / Q000601:surgery*; D055815:Young Adult
chemical_list: D000077324:Crystalloid Solutions; D007552:Isotonic Solutions