Reduction in same-day readmission rate for orthognathic surgery with a new enhanced recovery after surgery protocol

A new Enhanced Recovery After Surgery (ERAS) protocol for orthognathic surgery, implementing standardized pre-, peri- and postoperative guidelines (i.e. systematic locoregional nerve blocks), was initiated in 2019 in our center. We evaluated how this ERAS protocol affected same-day discharge after orthognathic surgery.

A retrospective cohort study was performed on participants having undergone orthognathic surgery between 2015 and 2022 in our tertiary French department either via the former traditional non-ERAS or new ERAS protocol. The primary study endpoint was difference in unplanned same-day readmission (SDR) rate between protocol types. Multivariate logistic regression was used to identify predictors of SDR.

A total of 511 participants were included: n = 212 (41.5%) followed the non-ERAS protocol and n = 299 (58.5%) the ERAS protocol. SDR was significantly higher in the non-ERAS group (38.2%) compared to the ERAS group (24.1%) (p < 0.001), corresponding to a 37% relative reduction in SDR. In multivariate analysis, later surgery end time (_adjOR 1.2, p < 0.001), associated genioplasty (_adjOR 2.1, p = 0.0013), maxillary osteotomy (_adjOR 2.6; p = 0.0004), and combined osteotomy (_adjOR 4.1; p < 0.0001) were independently associated with higher SDR. Conversely, ERAS protocol implementation remained protective (_adjOR 0.5, p = 0.004). Interaction analysis demonstrated that ERAS protocol implementation significantly reduced the risk of SDR among patients undergoing combined osteotomy (_adjOR 0.39; p = 0.039).

ERAS protocol implementation reduced the risk of SDR with the greatest benefit observed for complex combined osteotomies.

Our ERAS protocol is safe and effective for promoting outpatient orthognathic surgery, particularly by reducing complications after complex procedures.