title: Improved Short-Term Outcomes following Orthognathic Surgery Are Associated with High-Volume Centers.
abstract: BACKGROUND
  Previous studies assessing outcomes following orthognathic surgery rely primarily on single-center/surgeon experience. In addition to issues of generalizability, these studies are limited in evaluating the effect of operative volume on patient outcomes.
  
  
  METHODS
  Orthognathic procedures were identified in the 1999 to 2011 Healthcare Cost and Utilization Project Nationwide Inpatient Sample. Outcomes included occurrence of any in-hospital complication, extended length of stay (>2 days), and increased costs (>$10,784). High-volume hospitals were defined as the 90th percentile of case volume or higher (>31 cases/year). Univariate and multivariate analyses were conducted to identify independent predictors of outcomes. Trend analyses were performed to assess changes in the annual rate of patients treated at high-volume hospitals over the study period.
  
  
  RESULTS
  Among 101,692 orthognathic surgery patients, 19.6 percent underwent concurrent ancillary procedures (i.e., genioplasty, rhinoplasty, or septoplasty), and 37.6 percent underwent double-jaw surgery. Fifty-three percent were treated at high-volume hospitals. High-volume hospitals more often performed ancillary procedures (21.4 percent versus 17.4 percent; p < 0.001) and double-jaw surgery (41.3 percent versus 33.4 percent; p < 0.001). After adjustments for clinical and hospital characteristics, patients treated at high-volume hospitals were less likely to experience any complication (OR, 0.75; 95 percent CI, 0.70 to 0.81; p < 0.001) and extended length of stay (OR, 0.71; 95 percent CI, 0.68 to 0.75; p < 0.001). There was a 2 percent annual increase in the rate of patients treated at high-volume hospitals over the study period (incidence rate ratio, 1.02; 95 percent CI, 1.01 to 1.03; p < 0.001).
  
  
  CONCLUSIONS
  The majority of orthognathic cases nationwide are performed at a small number of high-volume hospitals. These hospitals discharge patients earlier, perform more complex procedures, and have fewer complications.
  
  
  METHODS
  Risk, III.
authors.affiliation: Ann Arbor, Mich.; and New Haven, Conn.|From the Department of Surgery, Section of Plastic and Reconstructive Surgery, University of Michigan Health System; and the Department of Surgery, Section of Plastic and Reconstructive Surgery, Yale University School of Medicine.
authors.forename: Nicholas L
authors.initials: NL
authors.lastname: Berlin
authors.affiliation: Ann Arbor, Mich.; and New Haven, Conn.|From the Department of Surgery, Section of Plastic and Reconstructive Surgery, University of Michigan Health System; and the Department of Surgery, Section of Plastic and Reconstructive Surgery, Yale University School of Medicine.
authors.forename: Charles T
authors.initials: CT
authors.lastname: Tuggle
authors.affiliation: Ann Arbor, Mich.; and New Haven, Conn.|From the Department of Surgery, Section of Plastic and Reconstructive Surgery, University of Michigan Health System; and the Department of Surgery, Section of Plastic and Reconstructive Surgery, Yale University School of Medicine.
authors.forename: Derek M
authors.initials: DM
authors.lastname: Steinbacher
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000639:trends*; D006760:Hospitalization / Q000639:trends*; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007297:Inpatients; D007571:Jaw Diseases / Q000191:economics / Q000601:surgery*; D008297:Male; D056948:Orthognathic Surgical Procedures; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult