"A Paradigm Shift: Complex Triple-Jaw Orthognathic Surgery Performed in the Ambulatory Setting"

Triple-jaw surgery, defined as concurrent Le Fort I osteotomy, bilateral sagittal split osteotomy, and genioplasty, is traditionally performed inpatient with overnight admission. As complex care shifts toward ambulatory surgery centers (ASCs), the safety and feasibility of same-day discharge after complex orthognathic surgery warrant evaluation. We hypothesized that triple-jaw surgery with adjunctive procedures can be performed safely in an outpatient setting.

A retrospective review was performed of patients undergoing triple-jaw orthognathic surgery with at least 2 adjunctive procedures by a single surgeon at an ASC over an 18-month period. Primary outcomes included airway compromise, bleeding, hospital transfer, inpatient conversion, and admission. Secondary outcomes included nausea, vomiting, infection, hardware failure, 30-day emergency department visits, and revision surgery. Outcomes were compared with published inpatient cohorts.

177 patients were included. Mean age was 29.5 years, and 52.0% were female. Mean operative time was 200 ± 41.8 minutes, 83.6% received liposomal bupivacaine, and mean recovery time was 123.3 ± 38.8 minutes. Adjunctive procedures included autologous fat grafting, bone grafting, submental liposuction, dental extractions, and facial bone implants. No patients required hospital transfer, admission, or inpatient conversion. Vomiting occurred in 1.1%, hemorrhage in 0%, and infection in 1.1%. Hardware failure, airway compromise, return to the operating room for infection, and revision surgery were 0%. Several postoperative outcomes were significantly lower than published inpatient cohorts.

In a selected single-surgeon cohort, triple-jaw surgery with adjunctive procedures was feasible and safe with same-day discharge. ASC-based orthognathic surgery may represent an alternative to conventional hospital-based care.