title: Hypotensive Anesthesia Is Associated With Shortened Length of Hospital Stay Following Orthognathic Surgery.
abstract: OBJECTIVE
  To evaluate the impact of induced hypotensive anesthesia on length of hospital stay (LOS) for patients undergoing maxillary Le Fort I osteotomy in isolation or in combination with mandibular orthognathic surgery.
  
  
  METHODS
  A retrospective cohort study design was implemented and patients undergoing a Le Fort I osteotomy as a component of orthognathic surgery at the Mayo Clinic from 2010 through 2014 were identified. The primary predictor variable was the presence of induced hypotensive anesthesia during orthognathic surgery. Hypotensive anesthesia was defined as at least 10 consecutive minutes of a mean arterial pressure no higher than 60 mmHg documented within the anesthetic record. The primary outcome variable was LOS in hours after completion of orthognathic surgery. The secondary outcome variable was the duration of surgery in hours. Multiple covariates also abstracted included patient age, patient gender, American Society of Anesthesiologists score, complexity of surgical procedure, and volume of intraoperative fluids administered during surgery. Univariable and multivariable models were developed to evaluate associations between the primary predictor variable and covariates relative to the primary and secondary outcome variables.
  
  
  RESULTS
  A total of 117 patients were identified undergoing Le Fort I orthognathic surgery in isolation or in combination with mandibular surgery. Induced hypotensive anesthesia was significantly associated with shortened LOS (odds ratio [OR] = 0.33; 95% confidence interval [CI], 0.12-0.88; P = .026) relative to patients with normotensive regimens. This association between hypotensive anesthesia and LOS remained statistically significant in a subgroup analysis of 47 patients in whom isolated Le Fort I surgery was performed (OR = 0.13; 95% CI, 0.03-0.62; P = .010). Induced hypotensive anesthesia was not statistically associated with shorter duration of surgery.
  
  
  CONCLUSIONS
  Induced hypotensive anesthesia represents a potential factor that minimizes postoperative LOS for patients undergoing routine maxillary orthognathic surgery alone or in combination with mandibular procedures. Hypotensive anesthesia does not appear to be effective in minimizing the duration of surgery within this same patient population.
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: 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: Associate Professor and Consultant, Department of Anesthesiology, Mayo Clinic and Mayo College of Medicine, Rochester, MN.
authors.forename: Toby N
authors.initials: TN
authors.lastname: Weingarten
authors.affiliation: Assistant Professor and Consultant, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN.
authors.forename: James M
authors.initials: JM
authors.lastname: Van Ess
authors.affiliation: Assistant Professor 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
authors.affiliation: Assistant Professor 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
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000766:Anesthesia, Dental / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D063172:Genioplasty / Q000379:methods; D006801:Humans; D007023:Hypotension, Controlled / Q000379:methods*; D007430:Intraoperative Care; D007902:Length of Stay; D008297:Male; D061646:Operative Time; D056948:Orthognathic Surgical Procedures / Q000379:methods*; D019340:Osteotomy, Le Fort / Q000379:methods; D059229:Osteotomy, Sagittal Split Ramus / Q000379:methods; D062072:Patient Acuity; D012189:Retrospective Studies; D012737:Sex Factors; D055815:Young Adult