title: Operative Time, Airway Management, Need for Blood Transfusions, and In-Hospital Stay for Bimaxillary, Intranasal, and Osseous Genioplasty Surgery: Current Clinical Practices.
abstract: OBJECTIVE
  The purpose of this study was to assess operative time, perioperative airway management, early postoperative cardiopulmonary health, need for blood transfusion, and in-hospital stay associated with simultaneous bimaxillary, intranasal, and osseous genioplasty surgery.
  
  
  METHODS
  The authors executed a retrospective cohort study derived from patients treated by 1 surgeon at a single institution from 2009 through 2014. The sample consisted of a consecutive series of patients with symptomatic chronic obstructed nasal breathing and a dentofacial deformity (DFD). All underwent at least a Le Fort I osteotomy, sagittal ramus osteotomies, septoplasty, inferior turbinate reduction, and osseous genioplasty. For each patient, the design of the osteotomies and the fixation techniques were consistent. The outcome variables included need for blood transfusion, operating time, success of nasotracheal intubation, time and place of extubation, early postoperative cardiopulmonary health, length of in-hospital stay, and need for readmission after surgery.
  
  
  RESULTS
  For the 166 patients studied, the average age was 25 years (range, 13 to 65 yr; 87 female patients [52%]). The primary patterns of presenting DFD included long face (43 of 166, 26%), maxillary deficiency (41 of 166, 25%), asymmetric mandibular excess (37 of 166, 22%), short face (28 of 166, 17%), and mandibular deficiency (15 of 166, 9%). Forty-two patients (25%) were confirmed to have symptomatic obstructive sleep apnea. The open wound operating time averaged 2 hours 59 minutes (standard deviation, 32 minutes). Only 3 of the 166 patients (1.8%) received blood transfusions. All patients underwent successful nasotracheal intubation. Ninety-six percent of patients were extubated in the operating room and the remaining 4% were extubated in the recovery room. No patients required reintubation or tracheostomy. One hundred thirty-seven patients (83%) were discharged after a 1- or 2-night in-hospital stay. Twenty-five (15%) required a 3-night stay and 4 (2%) required a 4-night hospital stay to achieve adequate oral intake. None of the patients required readmission.
  
  
  CONCLUSIONS
  This study confirms efficient surgical and anesthesia care for patients undergoing simultaneous bimaxillary orthognathic, intranasal, and osseous genioplasty. Anticipating safe nasotracheal intubation with extubation soon after surgery and a limited need for blood transfusion has proved to be the norm. This study confirmed an average in-hospital stay of 2 nights after complex orthognathic surgery without need for readmission.
authors: Director, Posnick Center for Facial Plastic Surgery, Chevy Chase, MD; Clinical Professor, Department of Surgery and Pediatrics, Georgetown University, Washington, DC; Clinical Professor, Department of Orthodontics, University of Maryland, School of Dentistry, Baltimore, MD; Adjunct Professor, Department of Oral and Maxillofacial Surgery, Howard University College of Dentistry, Washington, DC. Electronic address: jposnick@drposnick.com.
authors: Jeffrey C
authors: JC
authors: Posnick
authors: Chief Resident, Department of Oral and Maxillofacial Surgery, Howard University Hospital, Washington, DC.
authors: Elbert
authors: E
authors: Choi
authors: Resident, Department of Oral and Maxillofacial Surgery, Howard University Hospital, Washington, DC.
authors: Anish
authors: A
authors: Chavda
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D060666:Airway Extubation / Q000706:statistics & numerical data; D058109:Airway Management / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data; D015331:Cohort Studies; D063169:Dentofacial Deformities / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D063172:Genioplasty / Q000379:methods*; D006801:Humans; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015508:Nasal Obstruction / Q000601:surgery; D009300:Nasal Septum / Q000601:surgery; D061646:Operative Time; D056948:Orthognathic Surgical Procedures / Q000379:methods*; D019340:Osteotomy, Le Fort / Q000379:methods; D059229:Osteotomy, Sagittal Split Ramus / Q000379:methods; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000379:methods*; D020181:Sleep Apnea, Obstructive / Q000601:surgery; D014420:Turbinates / Q000601:surgery; D055815:Young Adult