Enhanced Recovery After Orthognathic Surgery: Evidence Synthesis for Postoperative Care

Enhanced recovery after surgery (ERAS) protocols have demonstrated substantial benefits across surgical specialties, including reduced hospital stays, decreased complications, and improved patient satisfaction. Despite growing interest in ERAS for orthognathic surgery, the optimal combination of postoperative elements remains undefined.

This evidence synthesis identifies, evaluates, and synthesizes postoperative outcomes following orthognathic surgery that are improved by ERAS protocols.

A systematic search of PubMed/MEDLINE, Cochrane Library, Embase, and Web of Science was conducted from inception through April 2025. Studies were included if they evaluated postoperative elements of ERAS protocols in orthognathic surgery with reported outcomes on length of stay, pain, opioid consumption, postoperative nausea and vomiting (PONV), or complications. Articles were screened by 2 independent reviewers following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Six studies (986 patients) met inclusion criteria. Evidence quality, assessed using Grading of Recommendations Assessment, Development, and Evaluation, was moderate for multimodal pain management and PONV prophylaxis but low to very low for mobilization, nutrition, and discharge planning. The strongest evidence supported scheduled nonopioid analgesics with limited opioids for breakthrough pain, which reduced maximum pain scores (5.50 ± 2.20 vs 7.50 ± 1.73, P < .001) and opioid consumption (9.38 ± 11.42 mg vs 51.44 ± 30.67 mg, P < .001). Risk-stratified multimodal PONV prophylaxis reduced PONV incidence (38.3 vs 63.2%, P = .005). Standardized discharge criteria facilitated same-day discharge (86.8 vs 20%, P < .01). Evidence for mobilization, nutrition management, and functional rehabilitation was limited and inconsistent.

Implementation of ERAS protocols for orthognathic surgery was associated with improved pain control, lower opioid consumption, decreased PONV, and shorter length of stay. Scheduled nonopioid analgesics, limited use of opioids for breakthrough pain, and risk-stratified PONV prophylaxis showed the most consistent benefits. Future research should address knowledge gaps regarding early mobilization, nutrition management, and standardized discharge planning through well-designed prospective studies.