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Evaluating The Impact Of Virtual Surgical Planning On National Trends In Orthognathic Surgery
Yida Cai, BA1, Ashley E. Rogers, MD2, Mohamed Awad, MD1, Samuel Boas, BS1, Arvin Smith, BS1, Lesley Summerville, BS, ScM1, Edward H. Davidson, MD1, Stephen B. Baker, MD, DDS2, Anand Kumar, MD1.
1Case Western Reserve University School of Medicine, Cleveland, OH, USA, 2MedStar Georgetown University Hospital, Washington, DC, USA.

PURPOSE: The 2010 introduction of virtual surgical planning (VSP) has revolutionized the treatment of dentofacial conditions by eliminating the need for a dental lab. Physician-reported trends of orthognathic surgery from the mid-2000s, prior to the introduction of VSP, suggested a significant reduction in orthognathic surgical volume. We hypothesize that the introduction of VSP in 2010 significantly reversed this trend. The aim of this study is to evaluate orthognathic surgical trends in volume using the NIS, the largest all-payer national healthcare database. METHODS: The Healthcare Cost and Utilization Project National Inpatient Sample (NIS) database was analyzed from January 2007 to December 2014. All patients who were diagnosed with dentofacial and malocclusion conditions and subsequently underwent orthognathic surgery were included. Hospitalizations in the NIS were then weighted to predict national trends in hospitalization volume for procedures over multiple years. Regression discontinuity design was used to analyze the effect of the introduction of virtual surgical planning on procedure volume in the years following its debut. RESULTS: 116,967 patients were diagnosed with dentofacial and malocclusion conditions, including maxillary hypoplasia (22,348, 19.1%), cleft palate (11,936, 10.2%), mandibular hypoplasia (10,075, 8.6%) and other related conditions (72,608, 62.1%) during hospitalization, nationally, between January 2007 and December 2014. Of these patients, 43,590 (37.3%) received orthognathic surgery including: segmental or total osteoplasty of the maxilla (27,454, 63.0%), osteoplasty of the mandible (10,315, 23.7%), genioplasty (683, 1.6%) or other facial bone repair and reconstruction (1,903, 4.4%) and were included in the study. Regression discontinuity design with a cut-off of January 2010 showed a significant (p = 0.01) increase in procedure volume by approximately 24.5 percentage points (95% confidence interval: 21.6 to 28.4 percentage points) following the introduction of VSP techniques that year. The regression additionally identified a decreasing trend in procedure volume from January 2007 to January 2010, prior to the introduction of VSP (Coefficient = -170, p = 0.06). CONCLUSION: Our study demonstrated a significant increase in orthognathic surgery that was temporally correlated with the introduction of VSP in 2010. This increased volume of procedures is a clear interruption of a decreasing trend in orthognathic surgery identified in the prior decade. Further studies will evaluate the impact of VSP on cost and hospital length of stay.


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