Outpatient Anesthesia Morbidity and Mortality Experience Among Massachusetts Oral and Maxillofacial Surgeons.

PURPOSE: The purpose of this retrospective study was to document the prevalence of different complications and the mortality rate for outpatient procedures performed under anesthesia by oral and maxillofacial surgeons in the Commonwealth of Massachusetts. MATERIALS AND METHODS: A mailed questionnaire was filled out by active members of the Massachusetts Society of Oral & Maxillofacial Surgeons who practiced using the single-operator-anesthetist model. Morbidity and mortality information was acquired for calendar years 2015 and 2016. RESULTS: The findings of this study were consistent with those of previous publications on the same topic. No office deaths occurred, and the mortality rate was 0 of 431,680 patient visits. The prevalence of other anesthesia-related complications was low. CONCLUSIONS: On the basis of the results of our study, we can conclude that the office-based team model used by oral and maxillofacial surgeons in Massachusetts for the delivery of outpatient anesthesia is safe with a low complication rate.

Postoperative Pain and Opioid Analgesic Requirements After Orthognathic Surgery.

PURPOSE: The purpose of this study was to determine the effect of individual characteristics, such as age, gender, and type of surgery, on postoperative pain intensity and opioid analgesic consumption after orthognathic surgery. PATIENTS AND METHODS: This prospective observational study was conducted at a single academic medical center during a 12-month period from 2015 to 2016. Thirty of 125 patients 18 to 65 years of age who had American Society of Anesthesiologists status I and II and were admitted to the hospital after orthognathic surgery were recruited. The main outcome variable was opioid analgesic consumption measured in morphine milligram equivalents (MME) during the patients' hospital stay. Secondary outcome variables were postoperative pain intensity measured using the numeric rating scale (0 to 10) and length of hospital stay. Data on age, gender, type of surgery, postoperative pain intensity, and opioid and nonopioid analgesic consumption for each 24-hour period during hospitalization were collected. The analgesic regimen consisted of oxycodone, hydromorphone, and acetaminophen. Differences in postoperative pain and opioid requirements between men and women, older and younger, and 1- and 2-jaw surgery were assessed using unpaired Student t test for statistical analysis. A P value less than .05 was considered statistically significant. RESULTS: Thirty patients (14 men, 16 women) with an average age of 26.3 years (18 to 50 yr) were admitted to the hospital for an average of 61 hours (24 to 170 hours) after orthognathic surgery. Twenty-three of 30 patients (77%) had bimaxillary surgery. The average postoperative pain score was 6.0 (2 to 8.5) on a scale of 0 to 10 and average opioid consumption was 106 MME (range, 0 to 407 MME). Women reported more postoperative pain (6.3 vs 5.3) and consumed more opioid analgesic than men (131 vs 78 MME). Patients younger than 25 years required 112 MME of opioid compared with 98 MME for those older than 25 years, although the 2 age groups reported similar pain scores. Patients who had 2-jaw surgery and mandibular (1-jaw) surgery reported more pain and required more opioid analgesics than those who had only maxillary surgery. CONCLUSION: Based on these study results, there appears to be a trend for increased opioid analgesic requirement in women and younger patients during the immediate postoperative period after orthognathic surgery.