Is Same-Day Discharge Safe Following Orthognathic Surgery?

[BACKGROUND] Outpatient orthognathic surgery has garnered increasing interest amid rising health care costs and the growing adoption of enhanced recovery after surgery protocols. However, the safety of same-day discharge remains unclear.

[PURPOSE] The purpose of this study was to compare postoperative outcomes between patients discharged the same day (day surgery [DS]) and those admitted overnight (same-day admission [SDA]) following orthognathic surgery.

[STUDY DESIGN, SETTINGS, AND SAMPLE] A retrospective cohort study was conducted at McGill University Health Centre, reviewing orthognathic surgeries performed between July 2019 and December 2023. Patients with isolated genioplasty, combined total joint replacement or distraction osteogenesis, or incomplete records were excluded.

[PREDICTOR VARIABLE] The primary predictor variable was admission status, defined as DS with same-day discharge or SDA with at least one overnight stay.

[MAIN OUTCOMES VARIABLES] The primary outcome was safety measured by occurrence of postoperative complications requiring emergency department visit or return to the operating room (OR) within 30 days.

[COVARIATES] Covariates included demographics, comorbidities, surgical type, and perioperative parameters.

[ANALYSES] Inverse probability weighting using propensity scores was applied to reduce the bias by creating comparable groups that are balanced on observed subjects' characteristics. Multiple imputations by chained equations were used to handle missing data. Weighted logistic regression was used to estimate the odds of postoperative complications. Two-sided tests were performed at a significance level of 0.05.

[RESULTS] The sample included 464 subjects with a median age of 26 years (interquartile range: 21 to 33), of whom 242 (52.2%) were female. The DS cohort comprised 282 (60.8%) subjects and was more frequently underwent single jaw procedures (76.3 vs 15.3%). Within 30 days, emergency department visits (3.5 vs 2.2%), return to the OR (2.5 vs 2.7%), and complication rates (5.7 vs 4.9%) were similar between DS and SDA groups. After propensity score-based inverse probability weighting adjustment, no significant difference in postoperative complications was observed (OR: 1.43; 95% confidence interval [CI]: (0.27 to 7.62); P = .8). Median postanesthesia care unit time was 183 minutes (interquartile range: , 132 to 250).

[CONCLUSIONS AND RELEVANCE] The same-day discharge after orthognathic surgery appears safe and feasible for appropriately selected patients. Accordingly, we have developed a standardized pathway to guide patient selection and facilitate integration into institutional enhanced recovery after surgery protocols.