The Outcomes of Orthognathic Surgery: An Analysis Utilizing the Pediatric Health Information System (PHIS) Database
Diana S. Jodeh, MD, Anh Thy H. Nguyen, MSPH, S. Alex Rottgers, MD.
Johns Hopkins All Children's Hospital, St.Petersburg, FL, USA.
PURPOSE: Previous attempts in reporting morbidity following orthognathic surgery have been limited to single-center case series or national surveys. This limitation can be overcome by querying large databases created by healthcare governing bodies or healthcare alliances. The aim of the present study was to provide a nationally representative estimate of the number and type of different orthognathic procedures performed in children's hospitals in the United States and furthermore to examine the effect of the type/combination of orthognathic procedures and demographic variables on the clinical outcomes.
METHODS: Data from the Pediatric Health Information System (PHIS) database was utilized for this analysis. Patients, 13 years of age or older, who underwent orthognathic procedures (ICD9 procedure codes: 76.64, 76.65, 76.66, 76.62, 76.63, 76.67, 76.68) between 2004 and 2014 were included. Subsequent debridement, excision, or destruction of lesion of facial bone (ICD9 code: 76.2), or removal of internal fixation device from the facial bone (ICD9 code: 76.97), between 2004 and 2015 were identified and used as surrogates for malunion, nonunion, and infection complications. Outcomes, including complications, length of stay, 30-day and 90-day readmissions were examined.
RESULTS: 5646 patients were identified. The average age of hospitalized patients was 17.6 years. Seventy percent were of Caucasian ethnicity. Sixty percent were females. Le Fort 1 was the procedure performed most often (39.4%), followed by Le Fort 1 with Bilateral Sagittal Split Osteotomy (BSSO) (22.41%), and BSSO alone (19.55%). The average length of stay was 2.14 days. Thirty-day and ninety-day readmission was 5.44% and 11.25% respectively. The overall complication rate was 10.4 %. Le Fort 1 had the highest complication rate (13%) followed by BSSO (12%).
CONCLUSION: Utilizing a large, multi-institution billing database we were able to estimate hospital discharge patterns and outcomes in patients undergoing orthognathic surgeries in United States hospitals. Additional future studies will examine additional factors associated with outcomes.
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