Epidemiologic trends and increasing inequalities in orthognathic surgery in Germany: a nationwide analysis 2005-2022

Orthognathic surgery (OS) has become a widely used treatment option for moderate to severe dento-skeletal malocclusions. The aim of this study was to analyze the incidence and time trends of OS and potential influencing factors in the German healthcare system. Nationwide data regarding the national diagnosis-related-group (DRG) inpatient billing system was received from the German Federal Statistical Office. We estimated age-gender standardized incidence of OS-associated procedures between 2005 and 2022 and evaluated age- and gender-adjusted time trends using Poisson regression analysis. The total standardized incidence rate of OS-associated procedures in the observational period 2005-2022 was 11.1 (♀13.0; ♂ 9.2) per 100,000 person years. A significant increase of 61.8% (♀+48.7%; ♂+82.9%) in OS-associated procedures was observed within the observational period, mainly due to the increase of the procedures in the age groups 15-34 years (+ 53.6%), 35-59 years (+ 66.7%) and 60-79 years (+ 20.0%). Mandibular procedures increased by 45.0%, while maxillary procedures increased by 88.2%. There were significant differences of the incidence of OS-associated procedures between the various federal states in Germany, indicating a higher incidence and stronger increase in more affluent regions. The age- and gender-standardized incidence of OS-associated procedures increased among all genders and the most relevant age groups in Germany in the last two decades. There is an ongoing trend to implement maxillary and combined procedures. These effects are limited to more affluent regions only, reflecting the impact of socioeconomic and regional factors on healthcare accessibility.