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Ambulatory sagittal split ramus osteotomy: strategy for enhanced recovery after surgery
1Department of Plastic Surgery, Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, Setagaya-ku, Tokyo, Japan.
International Journal of Oral and Maxillofacial Surgery
|September 13, 2022
Summary
Ambulatory sagittal split ramus osteotomy (SSRO) is safe and effective for elective cases. Advances in surgical and anesthetic care allow most patients to go home the same day, reducing hospital stays.
Area of Science:
- Oral and Maxillofacial Surgery
- Anesthesiology
- Patient Recovery
Background:
- Sagittal split ramus osteotomy (SSRO) traditionally requires inpatient stays due to anesthesia duration and complication risks.
- Postoperative complications like bleeding, pain, nausea, and vomiting have historically necessitated inpatient management.
- Recent advancements in surgical and anesthetic techniques have mitigated these risks and shortened hospital stays.
Purpose of the Study:
- To evaluate the feasibility and safety of performing sagittal split ramus osteotomy (SSRO) in an ambulatory (outpatient) setting for elective cases.
- To assess the outcomes of outpatient SSRO, including complication rates and same-day discharge success.
- To determine if modern perioperative management supports same-day discharge after SSRO.
Main Methods:
- Retrospective review of clinical records for patients undergoing outpatient SSRO between August 2011 and September 2020.
- Analysis of data including patient demographics, surgical procedures (isolated vs. concomitant), operative time, intraoperative bleeding, and admission status.
- Inclusion of 143 patients who underwent bilateral SSRO.
Main Results:
- A total of 143 patients underwent bilateral SSRO, with 73 having it as an isolated procedure and 70 concomitantly with other surgeries.
- An overwhelming majority (99.3%, 142/143 patients) were discharged on the same day of surgery.
- Only one patient (0.7%) required an overnight stay due to a submental hemorrhage post-genioplasty; no emergency readmissions occurred.
Conclusions:
- Sagittal split ramus osteotomy (SSRO) can be safely and successfully performed as an ambulatory procedure in elective settings.
- Multimodal perioperative management strategies are key to facilitating enhanced recovery and enabling same-day discharge.
- Outpatient SSRO demonstrates a high success rate with minimal complications, challenging the traditional inpatient approach.
