AB199. SOH24AB_247. An audit of the perioperative management of patients who underwent orthognathic surgery in University Hospital Limerick over a two-year period
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AB199. SOH24AB_247. An audit of the perioperative management of patients who underwent orthognathic surgery in University Hospital Limerick over a two-year period

Francesca Lee, Saoirse Kilgarriff, Louise Barry, Mark Wilson, Akinsola Ogunbowale

Oral and Maxillofacial Department, University Hospital Limerick, Limerick, Ireland

Background: Orthognathic surgery is an elective procedure performed to achieve functional and aesthetic occlusal outcomes. An enhanced recovery after surgery (ERAS) protocol is widely used in surgical specialties to improve patient outcomes and decrease recovery time. Several studies have explored and demonstrated its benefit in orthognathic surgery. The primary outcome measures are post-operative opioid consumption and episodes of post-operative nausea and vomiting (PONV). We analyzed the current perioperative regimen and recommend an ERAS protocol to achieve the desired perioperative goals.

Methods: A retrospective study was carried out involving patients who underwent orthognathic surgery between October 2021–October 2023 in the Oral and Maxillofacial Department in University Hospital Limerick. Post-operative opioid requirements in morphine milligram equivalents (MME) and PONV were recorded and compared against a study by Stratton et al. [2021] where the ERAS intervention group consisted of 71 patients.

Results: In a cohort of 45 non-ERAS patients, average opioid consumption was 36.3 MME compared to 31.2 MME among the ERAS group. The incidence of PONV was 50.5% among non-ERAS patients and 53% among the ERAS group. Non-ERAS patients experienced more discrete episodes of PONV compared to ERAS patients.

Conclusions: This audit demonstrates the benefit of adopting ERAS following orthognathic surgery. This begins pre-operatively with patient counselling, nutrition optimization and the use of multimodal analgesia and anti-ematics. Intra-operative techniques include administration of fentanyl, tranexamic acid, propofol and long-acting local anesthesia at closure. Post-op analgesia and anti-ematics should be administered regularly and early mobilization should be encouraged to facilitate rapid return to normal activity.

Keywords: Analgesia; anti-ematics; opioids; orthognathic; nausea

Acknowledgments

Funding: None.

Footnote

Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/map-24-ab199
Cite this abstract as: Lee F, Kilgarriff S, Barry L, Wilson M, Ogunbowale A. AB199. SOH24AB_247. An audit of the perioperative management of patients who underwent orthognathic surgery in University Hospital Limerick over a two-year period. Mesentery Peritoneum 2024;8:AB199.

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