title: Does Practice Type Determine the Complexity of Patients Encountered for Orthognathic Surgery?
abstract: OBJECTIVE
  This study sought to determine whether the type of oral and maxillofacial surgery (OMS) practice dictated the complexity of patients encountered for orthognathic surgery and to determine whether there were meaningful differences in comorbidities between patient groups.
  
  
  METHODS
  This was a retrospective cohort study of orthognathic surgical patients operated on by surgeons at an academic medical center (AMC; OMS department at the University of Alabama-Birmingham) compared with a private practice (PP) group that also operated at the AMC auxiliary facility. Surgical procedures included in this study were Le Fort osteotomy, bilateral sagittal split osteotomy, genioplasty, and combinations of these procedures. An experienced surgeon scrutinized the medical records of the AMC and PP groups for age, gender, medical history, American Society of Anesthesiologists (ASA) classification, and indications for surgical procedures. These data were statistically compared for differences in patient complexity.
  
  
  RESULTS
  The average age of patients in the 2 groups was similar (AMC, 29 yr; PP, 27 yr). Many more females were treated in the PP setting (male-to-female ratio, 1.06:1 in the AMC group and 1:1.6 in the PP group). The AMC group had a larger percentage of patients with medical comorbidities, a larger proportion of patients with ASA class 2 or 3, and a larger proportion of patients who underwent procedures for reasons other than malocclusion or cosmetic purposes, and these proportions were statistically relevant. Average length of surgery and average length of stay were longer in the AMC group.
  
  
  CONCLUSIONS
  This retrospective cohort study suggests that OMS departments in AMCs tend to treat orthognathic surgical patients with increased comorbidities and systemic illnesses and operate on a larger percentage of patients with concomitant dentofacial issues versus more routine dentofacial skeletal and occlusion deformities.
authors.affiliation: Resident, Department of Oral and Maxillofacial Surgery, University of Alabama-Birmingham, Birmingham, AL. Electronic address: dadenson1@gmail.com.
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Denson
authors.affiliation: Department Head, Department of Oral and Maxillofacial Surgery, University of Alabama-Birmingham, Birmingham, AL.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Waite
authors.affiliation: Private Practice, Atlanta, GA.
authors.forename: Hari
authors.initials: H
authors.lastname: Digumarthi
authors.affiliation: Private Practice, Birmingham, AL.
authors.forename: Joshua E
authors.initials: JE
authors.lastname: Everts
mesh_terms: D000328:Adult; D000407:Alabama / Q000453:epidemiology; D002908:Chronic Disease / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D056948:Orthognathic Surgical Procedures; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors