Reduction in same-day readmission rate for orthognathic surgery with a new Enhanced Recovery After Surgery protocol

Reduction in same-day readmission rate for orthognathic surgery with a new Enhanced Recovery After Surgery protocol | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Reduction in same-day readmission rate for orthognathic surgery with a new Enhanced Recovery After Surgery protocol Samy Bencherqui, Frédéric Lauwers, Marion Mure, Raphaël Costes, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7453620/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Objectives We aimed to evaluate how a newly implemented Enhanced Recovery After Surgery (ERAS) protocol affected same-day discharge after orthognathic surgery. Materials and Methods A retrospective, cohort study was performed on participants having undergone orthognathic surgery between 2015 and 2022 in our tertiary French department either via the former traditional non-ERAS or new ERAS protocol. The primary study endpoint was difference in unplanned same-day readmission (SDR) rates between protocol types. Multivariate logistic regression was used to identify predictors of SDR. Results A total of 511 participants were included: n = 212(41.5%) followed the non-ERAS protocol and n = 299(58.5%) the ERAS protocol. SDR was significantly higher in the non-ERAS group (38.2%) compared to the ERAS group (24.1%) (p < 0.001), corresponding to a 37% relative reduction in SDR. In multivariate analysis, later surgery end time ( adj OR 1.2, 95%CI 1.1–1.3; p < 0.001), associated genioplasty ( adj OR 2.1, 95%CI 1.3–3.3; p = 0.0013), maxillary osteotomy ( adj OR 2.6, 95%CI 1.5–4.4; p = 0.0004), and combined osteotomy ( adj OR 4.1, 95%CI 2.5–6.8; p < 0.0001) were independently associated with higher SDR. Conversely, ERAS protocol implementation remained protective ( adj OR 0.5, 95%CI 0.3–0.8; p = 0.004). Interaction analysis demonstrated that ERAS protocol implementation significantly reduced the risk of SDR among patients undergoing combined osteotomy ( adj OR 0.39, 95%CI 0.16–0.95; p = 0.039). Conclusions ERAS protocol implementation reduced the risk of SDR with the greatest benefit observed for complex combined osteotomies. Clinical Relevance These findings support our ERAS protocol as a safe and effective for promoting outpatient orthognathic surgery, particularly in reducing complications after complex procedures. Orthognathic surgery Enhanced Recovery After Surgery Protocol Same-day readmission Outpatient Fast-track Introduction Orthognathic surgery, a specialized field of oral and maxillofacial surgery, corrects dentofacial deformities to restore functionality and esthetic harmony. Traditionally, these procedures required extensive hospitalization and postoperative care [ 1 ]. However, recent progress in surgical techniques and perioperative management are encouraging a shift toward an increase in outpatient approaches [ 2 – 5 ]. This trend has been influenced by growing findings in other surgical specialties showing positive outcomes after the implementation of new multidisciplinary protocols to minimize postoperative complications and enhance recovery [ 6 ]. In all, these enhanced recovery after surgery (ERAS) protocols have been found effective in reducing hospital stays and improving patient satisfaction [ 7 ]. In the context of ambulatory orthognathic surgery, the need for optimized ERAS protocols is underscored by epidemiological data denoting a growing global demand for and rise in orthognathic interventions, including in France [ 8 ]. Furthermore, technological advances, such as computer-assisted planning and surgical navigation, have helped reduce surgery durations and increase overall precision in orthognathic procedures [ 9 , 10 ]. The implementation of modern anesthesiology [ 11 ], such as opioid-free anesthesia (OFA), dexmedetomidin or systematic trigeminal regional blocks, is an example of how former protocols have been improved. Accordingly, notable improvements in postoperative nausea and vomiting (PONV)–a common complication after orthognathic procedures–have been reported [ 12 – 14 ]. To date, fast-track strategies for orthognathic surgery have largely focused on the effects of ERAS protocols on same-day readmission (SDR) rate for bimaxillary osteotomy surgeries [ 5 ] and bilateral sagittal split osteotomy (BSSO) surgeries [ 3 ], without yet identifying any risk factors for the contraindication of outpatient orthognathic surgeries. Pekkari et al. [ 15 ] have also highlighted that effective communication and patient counseling on postoperative care are critical for ensuring the safety of outpatient surgeries. While varying across countries and centers, the implementation of ERAS strategies in the context of orthognathic surgery still remains generally modest. These differences can be attributed at least partly to variations in established guidelines. Indeed, some state the need for more robust scientific data before adopting ERAS protocols [ 2 , 11 ], likely hindering a broader acceptance and thus implementation. Meanwhile, the consequences of inadequately-managed outpatient strategies can be serious. Unplanned admissions following ambulatory surgeries can lead to increased healthcare costs, strain on hospital resources, and diminished patient satisfaction [ 16 ]. Poorly planned transitions to outpatient care often result in complications related to inadequate postoperative monitoring, such as airway swelling or inadequate pain control, which may require emergency interventions [ 15 ]. It is therefore crucial to evaluate the effectiveness, safety, and cost-efficiency of current ERAS approaches to further promote outpatient orthognathic strategies. Our study here is based on our new ERAS protocol that we have been implementing since 2019 in our French tertiary department for the promotion of outpatient orthognathic surgery. We aimed to evaluate the effectiveness and safety of this protocol for same-day discharge. For this purpose, we compared unplanned SDR among participants having undergone the traditional non-ERAS versus new ERAS protocol. We additionally determined the potential risk factors associated with unplanned SDR under the ERAS protocol. Methods Study Design We conducted a single-center, retrospective, comparative, cohort study of medical records from patients having undergone orthognathic surgery between January 1 2015 and December 31 2022 in our tertiary maxillofacial surgery department. A new ERAS protocol was initiated in 2019 for orthognathic procedures in our department and so study participants were consecutively divided into two groups based solely on if they underwent the traditional protocol (non-ERAS group) or the new ERAS protocol (ERAS group). All procedures performed were part of routine care, and both in accordance with institutional guidelines and with the tenets of the 1964 Helsinki Declaration. Ethical approval was waived by the IRB of Toulouse University Hospital given the retrospective and non-interventional nature of the study as asserted by the French Jardé Ethical and Regulatory Law. All participants or their relatives received clear written information and gave free and written informed consent to participate. All data have been anonymized for publication. Participant Selection Inclusion criteria comprised individuals of any age who underwent a BSSO, single primary Le Fort I osteotomy (or maxillary osteotomy: MO), or combined osteotomy (or combined osteotomy: CO), as well as individuals with data available for pre- and early postoperative assessments. Exclusion criteria included individuals with comorbidities leading to anticipated unplanned readmissions and with multiple surgical procedures on the same day. Protocol Description The differences between the non-ERAS (traditional) and ERAS protocols are described in detail in Table 1 . Briefly, the ERAS protocol includes multidisciplinary: preoperative counseling, nutrition optimization, minimization of fasting periods, utilization of multimodal analgesia, PONV prevention, preoperative trigeminal loco-regional anesthetic block [ 17 ], perioperative blood management, early postoperative mobilization, and standardized discharge plans. Preoperative counseling comprised informing on expected outcomes and potential complications, as well as postoperative care instructions aimed at reducing anxiety and enhancing recovery. Patient discharge was validated by operating surgeons. Note that same-day discharge was contraindicated in the event of delayed or no oral feeding (non-ERAS protocol) or delayed or no oral drinking (ERAS protocol) within 24 hours after surgery. All patients required fulfilling these criteria to be able to discharge : stable and appropriate vital signs and mental status, sufficient control of pain and PONV, absence of surgical site complications, ability to drink and ambulate, and patient confidence in their recovery at home and agreement of readiness for discharge. Patients did not beneficiate of surgical site draining. Table 1 Descriptions of the traditional non-Enhanced Recovery After Surgery (ERAS) and ERAS protocols implemented in our department Phase Non-ERAS ERAS Pre-operative Patient blood management Anemia screening not systematic Systematic anemia screening Surgery delay if anemia with iron supplementation Patient counseling By operating surgeon By operating surgeon, anesthesiologist, dietitian Perioperative Induction Hypnotics Propofol/Sevoflurane Propofol TCI, BIS monitoring Curarisation Not systematic Intubation with remifentanil Not systematic Intubation with remifentanil or atracurium if sedation with dexmedetomidine TOF monitoring Pain management Locoregional blocks Echo-guided maxillary nerve block by anesthesiologist, mandibular vestibular infiltration with xylocaïne and adrenalin Systematic echo-guided maxillary and mandibular nerves block by anesthesiologist Morphine TCI Sufentanil - remifentanil Remifentanil or OFA (dexmedetomidine) Nociception monitoring Not systematic NOL Patient blood management Tranexamic acid not systematic Systematic tranexamic acid PONV prevention Dexamethasone Metoclopramid Dexamethasone OFA Ondansetron Antalgics Paracetamol, ketoprofen, +- nefopam Paracetamol, ketoprofen, +- nefopam Postoperative Antalgics Prescription by surgeon Prescription by anesthesiologist Multimodal anesthesia with NSAIs Adapted galenics Patient counseling SDD failure No or delayed oral feeding Tachycardia No or delayed oral drinking Iron supplementation No Intravenous iron supplementation if blood loss > 500mL BIS: bispectral index; NOL: nociception level; NSAI: non-steroidal anti-inflammatory; OFA: opioid-free anesthesia; PONV: postoperative nausea and vomiting; SDD: same-day discharge; TCI: target-controlled infusion; TOF: train of four Data Collection Data on participant demographics (age, sex, weight, height), surgery duration, surgery end time, procedures performed (e.g., Le Fort I osteotomy, mandibular osteotomy), postoperative complications, and early readmissions were collected from medical records. Study outcomes Our primary study endpoint was the difference in rate of unplanned SDRs, which can also be described as unplanned next-day discharges or failed same-day discharges, between participants having undergone the ERAS versus non-ERAS protocols. Secondary study endpoints involved: (1) identifying independent variables associated with unplanned SDR, and (2) determining if ERAS status affected any associations found between independent variables and SDR. Statistical Analyses Based on our previous study indicating an SDR rate of 35% under traditional outpatient protocols [ 2 ] with an expected reduction to 20% under ERAS protocols, we calculated a target inclusion of 370 participants (185 in each group) to achieve 90% power at a 5% significance level using the free G*Power software version 3.1 ( https://www.psychologie.hhu.de/arbeitsgruppen/allgemeine-psychologie-und-arbeitspsychologie/gpower ). The characteristics of the cohort are described by frequencies and percentages (categorical variables) or means ± standard deviation (SD) (continuous variables). Between non-ERAS and ERAS groups, the Chi-squared test was used to compare the rates of: (1) SDR, and (2) SDR according to osteotomy procedure type performed. Logistic regression analysis identified predictive factors associated with SDR. The independent variables tested were sex, preoperative age (continuous), surgery duration (continuous), surgery end time (continuous), osteotomy type, associated genioplasty, and whether the ERAS protocol was used. Odds ratios with p values < 0.05 in bivariate analyses were included in the multivariate model. We then performed an interaction analysis to assess whether ERAS status modified the associations between SDR and the same independent variables. Statistical analyses were performed using the GraphPad Prism software version 10.0.0 (Boston, Massachusetts USA). The significance threshold was set to p-values < 0.05. Results Cohort demographic and clinical characteristics A total of 511 participants having undergone orthognathic surgery between January 1 2015 and December 31 2022 in our tertiary maxillofacial surgery department were included for study. No patients were excluded. The mean age was 23.5 ± 9.3 (13–57) years and 56.7% of participants were female. Most participants were discharged on the same day (n = 358/511; 70.0% participants) with an overall SDR rate of 30.0% for all surgeries combined. The mean surgery duration was 182 ± 68.4 minutes and 50% of all procedures were completed by 13:04 PM for all surgeries combined. The majority of procedures performed were BSSOs (51.5%), followed by COs (27.8%) and then MOs (20.7%). Genioplasty was associated for approximately one-fourth (25.8%) of total participants. The non-ERAS protocol was followed by 212 (41.5%) participants and the ERAS protocol was followed by 299 (58.5%) participants. Table 2 summarizes the demographic and clinical characteristics for the total cohort as well as for non-ERAS and ERAS groups. Note that surgery duration was + 18.7 minutes longer in the ERAS group (p = 0.001) but surgery end time showed no difference between the non-ERAS (13:45 PM) and ERAS (13:23 PM) groups (p = 0.29). Table 2 The demographic and clinical characteristics for the total cohort as well as for the non-enhanced recovery after surgery (ERAS) and ERAS groups Total cohort Non-ERAS group ERAS group Number of participants, n (%) 511 212 (41.5%) 299 (58.5%) Female sex, n (% per group) 290 (56.7%) 84 (39.6%) 137 (45.8%) Age, mean ± SD 23.5 ± 9.3 24.3 ± 10 22.9 ± 8.7 Surgery duration (min), mean ± SD 182,1 ± 68.4 171.0 ± 59.0 189.7 ± 73.4 Surgery end time (24 hours), mean 13:31 PM 13:45 PM 13:23 PM Type of procedure, n (% per group) Bilateral sagittal split osteotomy 263 (51.5%) 106 (50%) 157 (52.5%) Maxillary osteotomy 106 (20.7%) 48 (22.6%) 58 (19.4%) Combined osteotomy 142 (27.8%) 58 (27.4%) 84 (28.1%) Associated genioplasty, n (% per group) 132 (25.8%) 73 (34.4%) 59 (19.7%) Same-day readmission, n (% per group) 153 (30.0%) 81 (38.2%) 72 (24.1%) SD: standard deviation The effects of the Enhanced Recovery After Surgery Protocol on same-day readmission The SDR rate was significantly higher for the non-ERAS (38.2%) versus the ERAS (24.1%) group (p < 0.001) (Table 2 ), corresponding to a relative reduction of 37% in SDR rate with ERAS implementation. Table 3 depicts SDR rates according to both ERAS implementation and surgery procedure type. The specific SDR rates according to the type of surgery performed decreased with application of ERAS. BSSO had the lowest SDR rates among all the procedures, with a frequency of 17,5%. The ERAS group had a lower SDR rate than Non-ERAS group (14,1% vs. 22,6%). Maxillary osteotomy also had a lower SDR rate in the ERAS group than in the non-ERAS group (43.7% vs. 32.7%). However, these decreases were not statistically significant (respectively p = 0.07 and p = 0.24). The SDR rate for CO was significantly lower in the ERAS group than in the non-ERAS group (62.1% vs. 36.9%, p = 0.002). Table 3 Same-day readmission rates for osteotomy procedure type performed according to Enhanced Recovery After Surgery (ERAS) protocol implementation or not Same-day readmission, n(% per group) Total cohort (n = 511) Non-ERAS group (n = 212) ERAS Group (n = 299) p value A Osteotomy type All types combined 153/511 (30.0%) 81/212 (38.2%) 72/299 (24.1%) < 0.001 bilateral sagittal split osteotomy 46/263 (30.117.5%) 24/106 ( 2.6%) 22/157 (14.1%) 0.07 Maxillary osteotomy 40/106(37.8%) 21/46 (43.7%) 19/58 (32.7%) 0.24 combined osteotomy 67/142(47.2%) 36/48 (62.1%) 31/84 (36.9%) 0.002 A : Chi-squared test Predictors of same-day readmission In bivariate analyses (Table 4 ), later surgery end time ( adj OR 1.2; p < 0.001) and slightly longer surgery duration ( adj OR 1.004; p = 0.008), associated genoplasty ( adj OR 2.7; p < 0.0001), and both MO ( adj OR 2.9; p < 0.001) and CO ( adj OR 4.2; p < 0.001) procedures were found positively associated with SDR. Conversely, ERAS protocol implementation was found negatively associated with SDR ( adj OR 0.5; p < 0.001). Neither age ( adj OR 0.99; p = 0.61) nor sex ( adj OR 1.0; p = 0.81) were associated with SDR. After adjustment for confounders in the multivariate analysis (Table 4 ), later surgery end time ( adj OR 1.2; p < 0.001), associated genoplasty ( adj OR 2.1; =0.0013), and both MO ( adj OR 2.6; p = 0.0004) and notably CO ( adj OR 4.1; p < 0.0001) procedures were found independently positively associated with SDR. ERAS protocol implementation was found independently negatively associated with SDR ( adj OR 0.5; =0.004), indicating a 50% reduction in risk of SDR for participants in the ERAS group. The longer surgery duration association with SDR was not significant after adjustment. Table 4: Bivariate and multivariate regression analysis results demonstrating the predictors of same-day readmission A : bilateral sagittal split osteotomy as reference; SDR: same-day readmission The effects of the Enhanced Recovery After Surgery Protocol on independent variables associated with same-day readmission After introducing ERAS implementation effects into the multivariate model (Table 5 ), a significant interaction was observed between ERAS protocol implementation and CO (adjOR 0.39; p = 0.039), indicating that the ERAS protocol reduced the risk of SDR among patients undergoing COs. Only non-significant trends toward a protective effect against SDR were noted for the interactions between ERAS and the other independent variables. Table 5 Interaction analysis showing the effects of the Enhanced Recovery After Surgery (ERAS) protocol on the same independent variables associated with same-day readmission from Table 4 Interaction effect adj OR [95%CI] p value ERAS protocol + surgery duration 0.97 [0.92–1.01] 0.126 ERAS protocol + surgery end time 0.86 [0.67–1.11] 0.251 ERAS protocol + associated genioplasty 0.56 [0.25–1.26] 0.161 ERAS protocol + maxillary osteotomy 0.46 [0.20–1.08] 0.073 ERAS protocol + combined osteotomy 0.39 [0.16–0.95] 0.039 Discussion We evaluated the effectiveness and safety of our new ERAS protocol developed to promote outpatient orthognathic surgery. Overall, we demonstrate a significant reduction in SDR rates from 38.2% for participants having undergone the traditional non-ERAS surgical protocol to 24.1% for the ERAS protocol (p < 0.001), with reduced SDR significantly associated with surgeries via ERAS protocol implementation ( adj OR 0.5 [0.3–0.8]; p = 0.004). These findings align with recent literature on fast-track and ERAS pathways in orthognathic surgery, which consistently report improvements in patient safety, discharge rates, and reduced opioid consumption. Our regression analyses for identification of potential risk factors and ERAS interactions associated with increased SDR indicated us how ERAS affected outpatient strategy success. Firstly, neither age nor sex were associated with higher rates of SDR in bivariate analyses. Participants undergoing surgery later in the day had a higher risk for SDR ( adj OR 1.2 [1.1–1.3]; p > 0.001). The interaction study did not show a significant change in this association after ERAS protocol implementation ( adj OR 0.86 [0.67–1.11]; p = 0.251). We did however reveal a slight significant increase of approximately 19 minutes in surgical duration after ERAS protocol implementation. Interestingly, this rise could be attributed to more comprehensive perioperative assessments and adherence to protocol-related workflows that aim to optimize outcomes rather than accelerate discharge. The systematic use of echo-guided anesthesiologic blocks of maxillary and/or mandibular nerves could also underlie longer surgery durations. In our study, CO ( adj OR 4.1 [2.5–6.8]; p < 0.0001), and to a lesser extent MO ( adj OR 2.6 [1.5–4.4]; p = 0.0004), were associated with a higher risk of SDR compared to BSSO. However, interaction analysis – assessing how application of the ERAS protocol affected these associations between SDR and surgery type – showed a substantial reduction in approximately two-thirds in the association between SDR and CO ( adj OR 0.38 [0.17–0.95]; p = 0.039). Thus, application of the ERAS protocol allowed for the performance of this more invasive surgery without an increased risk of complications. Ferrara et al. [ 5 ] showed that an ERAS protocol increased same-day discharge after bimaxillary procedures while decreasing opioid use, supporting the concept that structured perioperative care can make even complex surgeries feasible in an outpatient setting. The same interaction effect was not significant for the association between SDR and MO ( adj OR 0.46 [0.20–1.08]; p = 0.073). This could be explained by the absence of mandibular nerve block in isolated genioplasty without ramic osteotomy, with genioplasty also found associated with increased risk of SDR ( adj OR 2.1 [1.3–3.3]; p = 0.0013). In all, these findings indicate that more complex procedures can be transitioned to outpatient care but require careful consideration [ 15 ], such as systematic mandibular blocks when feasible, intensified airway and edema monitoring, high-risk antiemetic prophylaxis, or structured home-care instructions. These findings collectively allow for a more precise definition of how to manage and promote outpatient strategies that are currently rarely performed in France [ 18 ]. Indeed, the authors declare that only 40% of surgeons apply fast-track strategies in the orthognathic field, mostly for Surgically assisted Rapid Palatal Expansion (SARPE), and that 92.3% required a 1–2 day hospital stay after BSSO and 86.5% after CO. In all, we show that our outpatient strategy with ERAS for BSSO, MO and CO is safe, with commonly considered risk factors, such as age, not being likely to influence SDR rates. From a medico-economic point-of-view, these results are encouraging for the consideration of shorter and yet safe hospital stays. Venugoplan et al. [ 19 ] have shown that patients undergoing orthognathic surgery had a mean hospital stay of 2.95 days, representing 30,580 days for 10,345 interventions. Shifting to a more ″outpatient-oriented″ paradigm could drastically reduce associated hospital stays, liberating hospital beds for other patients, thus limiting the risk of nosocomial infections and diminishing associated costs. Several study limitations must be acknowledged. Firstly, the retrospective nature of this cohort study means reliance on existing medical records, which could have resulted in inconsistencies in data collection and reporting practices. Furthermore, our study focused exclusively on a single center, limiting the generalizability of the results to broader clinical settings. Indeed, variability in patient demographics, surgical techniques, or protocols across different healthcare systems could yield different outcomes. Multicentric studies are therefore needed to validate our findings. Additionally, while the study examined certain predictors of readmission, it did not account for all possible confounding factors, such as psychological enthusiasm and socio-economic status; factors that can considerably impact both recovery and patient satisfaction after surgery [ 8 ]. These are shared with many prior fast-track studies [ 5 ] [ 20 ]. Future steps should therefore include multicenter prospective studies, development of a national ERAS registry for orthognathic surgery, and integration of patient-centered outcomes (e.g., QoR-15, satisfaction, anxiety). Lastly, the relatively short postoperative follow-up period may not adequately capture long-term outcomes or the full spectrum of potential complications associated with outpatient orthognathic procedures, necessitating further longitudinal studies to comprehensively evaluate the effectiveness and safety of ERAS methodologies [ 21 , 22 ]. Ongoing research into the optimization of postoperative care will be essential to further refine these protocols and address outcomes across various populations. Conclusions We found a significant reduction in the rate of SDR among participants having undergone the ERAS protocol (24.1%) versus the traditional protocol (38.2%), with a 50% reduction in risk of SDR for participants with ERAS implementation ( adj OR 0.5; p = 0.004). The ERAS protocol resulted in a significantly longer mean surgery duration (+ 19 minutes) and was most beneficial for reducing SDR for more complex combined orthognathic surgeries. The findings underscore the promising effects of implementing our ERAS protocol in outpatient orthognathic surgery. Our results also emphasize the need for tailored approaches in patient selection and management, particularly when addressing older outpatient candidates or those lacking an internal caregiver. Finally, future studies should explore the sustainability of these results over longer follow-up periods and assess the cost-effectiveness of these protocols within diverse healthcare systems. Declarations Acknowledgments We thank Jacqueline Butterworth, PhD (Toulouse University Hospital) for help with manuscript drafting and language. Ethics and consent All procedures performed were part of routine care, and both in accordance with institutional guidelines and with the tenets of the 1964 Helsinki Declaration. Ethical approval was waived by the IRB of Toulouse University Hospital given the retrospective and non-interventional nature of the study as asserted by the French Jardé Ethical and Regulatory Law. All participants or their relatives received clear written information and gave free and written informed consent to participate. All data have been anonymized for publication. Author contributions Samy Bencherqui: study conception and design, data acquisition and interpretation, manuscript drafting and revising; Frédéric Lauwers: data analysis and interpretation, manuscript revising; Marion Mure: data acquisition and manuscript revising; Raphaël Costes: data acquisition and manuscript revising; Hélios Bertin: data interpretation and manuscript revising; Pierre Corre: data interpretation and manuscript revising; Alice Prevost: study conception, design, and supervision, data analysis and interpretation, manuscript revising. Samy Bencherqui wrote the first article version, and all authors have approved the final version of the manuscript and agree to be accountable for all aspects of the work. Data availability The original participant data analyzed in this study are available from the corresponding author on reasonable request and after approval for data transfer by the IRB of Toulouse University Hospital. Funding No funding was received for this study. 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Journal of Craniofacial Surgery 29:e158–e161. https://doi.org/10.1097/SCS.0000000000004238 Esquerré T, Mure M, Minville V, et al (2024) Bilateral ultrasound-guided maxillary and mandibular combined nerves block reduces morphine consumption after double-jaw orthognathic surgery: a randomized controlled trial. Reg Anesth Pain Med rapm-2024-105497. https://doi.org/10.1136/rapm-2024-105497 Vanden Haute N, Bach E, Bouletreau P, et al (2025) An updated overview of orthognathic surgery practices in France. Journal of Stomatology, Oral and Maxillofacial Surgery 126:102210. https://doi.org/10.1016/j.jormas.2024.102210 Venugoplan SR, Nanda V, Turkistani K, et al (2012) Discharge patterns of orthognathic surgeries in the United States. J Oral Maxillofac Surg 70:e77-86. https://doi.org/10.1016/j.joms.2011.09.030 Davies LA, Crawford EMS, Jones JL, Jones SD (2018) Day-case bilateral sagittal split osteotomy. British Journal of Oral and Maxillofacial Surgery 56:968–971. https://doi.org/10.1016/j.bjoms.2018.09.012 Torres KV, Pessoa LS, Luna AHB, Alves GÂDS (2017) Quality of life after orthognathic surgery: a case report. Rev CEFAC 19:733–739. https://doi.org/10.1590/1982-021620171957517 Oliveira ZSBD, Silveira MLMD, Gomes PP, et al (2021) Early recovery after surgery protocol in orthognathic surgery: a randomized, blind clinical study. Braz oral res 35:e87. https://doi.org/10.1590/1807-3107bor-2021.vol35.0087 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 13 Jan, 2026 Reviews received at journal 20 Nov, 2025 Reviewers agreed at journal 04 Nov, 2025 Reviewers invited by journal 04 Nov, 2025 Editor assigned by journal 26 Aug, 2025 Submission checks completed at journal 26 Aug, 2025 First submitted to journal 25 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7453620","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":505647591,"identity":"c0dea04d-9c70-4345-8345-f828cb9e000e","order_by":0,"name":"Samy Bencherqui","email":"data:image/png;base64,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","orcid":"","institution":"Centre Hospitalier Universitaire de Nantes","correspondingAuthor":true,"prefix":"","firstName":"Samy","middleName":"","lastName":"Bencherqui","suffix":""},{"id":505647592,"identity":"fdcece02-2d90-44b1-9add-c3433c84999e","order_by":1,"name":"Frédéric Lauwers","email":"","orcid":"","institution":"Centre Hospitalier Universitaire de Toulouse","correspondingAuthor":false,"prefix":"","firstName":"Frédéric","middleName":"","lastName":"Lauwers","suffix":""},{"id":505647593,"identity":"ece84118-6934-45a6-8f75-6c7a2c26fb5f","order_by":2,"name":"Marion Mure","email":"","orcid":"","institution":"Centre Hospitalier Universitaire de Toulouse","correspondingAuthor":false,"prefix":"","firstName":"Marion","middleName":"","lastName":"Mure","suffix":""},{"id":505647594,"identity":"ee5502b8-6677-4137-aa2f-899755527b26","order_by":3,"name":"Raphaël Costes","email":"","orcid":"","institution":"Centre Hospitalier Universitaire de Toulouse","correspondingAuthor":false,"prefix":"","firstName":"Raphaël","middleName":"","lastName":"Costes","suffix":""},{"id":505647595,"identity":"b1880cc7-f1d1-447c-81f2-02f18e18f579","order_by":4,"name":"Hélios Bertin","email":"","orcid":"","institution":"Centre Hospitalier Universitaire de Nantes","correspondingAuthor":false,"prefix":"","firstName":"Hélios","middleName":"","lastName":"Bertin","suffix":""},{"id":505647596,"identity":"1b5cf411-0d61-4e55-aed4-ba01bf38abdd","order_by":5,"name":"Pierre Corre","email":"","orcid":"","institution":"Centre Hospitalier Universitaire de Nantes","correspondingAuthor":false,"prefix":"","firstName":"Pierre","middleName":"","lastName":"Corre","suffix":""},{"id":505647597,"identity":"0ac5adde-a804-4fee-b092-b87c463c824d","order_by":6,"name":"Alice Prevost","email":"","orcid":"","institution":"Centre Hospitalier Universitaire de Toulouse","correspondingAuthor":false,"prefix":"","firstName":"Alice","middleName":"","lastName":"Prevost","suffix":""}],"badges":[],"createdAt":"2025-08-25 12:08:33","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7453620/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7453620/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90294469,"identity":"6c8b29d1-a5e7-4bfd-8008-d8be5cd80793","added_by":"auto","created_at":"2025-09-01 07:59:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1075385,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7453620/v1/2ee172f9-3a67-4886-a9de-71d29bcbf107.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Reduction in same-day readmission rate for orthognathic surgery with a new Enhanced Recovery After Surgery protocol","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOrthognathic surgery, a specialized field of oral and maxillofacial surgery, corrects dentofacial deformities to restore functionality and esthetic harmony. Traditionally, these procedures required extensive hospitalization and postoperative care [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. However, recent progress in surgical techniques and perioperative management are encouraging a shift toward an increase in outpatient approaches [\u003cspan additionalcitationids=\"CR3 CR4\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. This trend has been influenced by growing findings in other surgical specialties showing positive outcomes after the implementation of new multidisciplinary protocols to minimize postoperative complications and enhance recovery [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In all, these enhanced recovery after surgery (ERAS) protocols have been found effective in reducing hospital stays and improving patient satisfaction [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn the context of ambulatory orthognathic surgery, the need for optimized ERAS protocols is underscored by epidemiological data denoting a growing global demand for and rise in orthognathic interventions, including in France [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Furthermore, technological advances, such as computer-assisted planning and surgical navigation, have helped reduce surgery durations and increase overall precision in orthognathic procedures [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The implementation of modern anesthesiology [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], such as opioid-free anesthesia (OFA), dexmedetomidin or systematic trigeminal regional blocks, is an example of how former protocols have been improved. Accordingly, notable improvements in postoperative nausea and vomiting (PONV)\u0026ndash;a common complication after orthognathic procedures\u0026ndash;have been reported [\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. To date, fast-track strategies for orthognathic surgery have largely focused on the effects of ERAS protocols on same-day readmission (SDR) rate for bimaxillary osteotomy surgeries [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] and bilateral sagittal split osteotomy (BSSO) surgeries [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], without yet identifying any risk factors for the contraindication of outpatient orthognathic surgeries. Pekkari et al. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] have also highlighted that effective communication and patient counseling on postoperative care are critical for ensuring the safety of outpatient surgeries.\u003c/p\u003e\u003cp\u003eWhile varying across countries and centers, the implementation of ERAS strategies in the context of orthognathic surgery still remains generally modest. These differences can be attributed at least partly to variations in established guidelines. Indeed, some state the need for more robust scientific data before adopting ERAS protocols [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], likely hindering a broader acceptance and thus implementation. Meanwhile, the consequences of inadequately-managed outpatient strategies can be serious. Unplanned admissions following ambulatory surgeries can lead to increased healthcare costs, strain on hospital resources, and diminished patient satisfaction [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Poorly planned transitions to outpatient care often result in complications related to inadequate postoperative monitoring, such as airway swelling or inadequate pain control, which may require emergency interventions [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. It is therefore crucial to evaluate the effectiveness, safety, and cost-efficiency of current ERAS approaches to further promote outpatient orthognathic strategies.\u003c/p\u003e\u003cp\u003eOur study here is based on our new ERAS protocol that we have been implementing since 2019 in our French tertiary department for the promotion of outpatient orthognathic surgery. We aimed to evaluate the effectiveness and safety of this protocol for same-day discharge. For this purpose, we compared unplanned SDR among participants having undergone the traditional non-ERAS versus new ERAS protocol. We additionally determined the potential risk factors associated with unplanned SDR under the ERAS protocol.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design\u003c/h2\u003e\u003cp\u003eWe conducted a single-center, retrospective, comparative, cohort study of medical records from patients having undergone orthognathic surgery between January 1 2015 and December 31 2022 in our tertiary maxillofacial surgery department. A new ERAS protocol was initiated in 2019 for orthognathic procedures in our department and so study participants were consecutively divided into two groups based solely on if they underwent the traditional protocol (non-ERAS group) or the new ERAS protocol (ERAS group).\u003c/p\u003e\u003cp\u003e All procedures performed were part of routine care, and both in accordance with institutional guidelines and with the tenets of the 1964 Helsinki Declaration. Ethical approval was waived by the IRB of Toulouse University Hospital given the retrospective and non-interventional nature of the study as asserted by the French Jard\u0026eacute; Ethical and Regulatory Law. All participants or their relatives received clear written information and gave free and written informed consent to participate. All data have been anonymized for publication.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eParticipant Selection\u003c/h3\u003e\n\u003cp\u003eInclusion criteria comprised individuals of any age who underwent a BSSO, single primary Le Fort I osteotomy (or maxillary osteotomy: MO), or combined osteotomy (or combined osteotomy: CO), as well as individuals with data available for pre- and early postoperative assessments. Exclusion criteria included individuals with comorbidities leading to anticipated unplanned readmissions and with multiple surgical procedures on the same day.\u003c/p\u003e\n\u003ch3\u003eProtocol Description\u003c/h3\u003e\n\u003cp\u003eThe differences between the non-ERAS (traditional) and ERAS protocols are described in detail in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Briefly, the ERAS protocol includes multidisciplinary: preoperative counseling, nutrition optimization, minimization of fasting periods, utilization of multimodal analgesia, PONV prevention, preoperative trigeminal loco-regional anesthetic block [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], perioperative blood management, early postoperative mobilization, and standardized discharge plans. Preoperative counseling comprised informing on expected outcomes and potential complications, as well as postoperative care instructions aimed at reducing anxiety and enhancing recovery. Patient discharge was validated by operating surgeons. Note that same-day discharge was contraindicated in the event of delayed or no oral feeding (non-ERAS protocol) or delayed or no oral drinking (ERAS protocol) within 24 hours after surgery. All patients required fulfilling these criteria to be able to discharge : stable and appropriate vital signs and mental status, sufficient control of pain and PONV, absence of surgical site complications, ability to drink and ambulate, and patient confidence in their recovery at home and agreement of readiness for discharge. Patients did not beneficiate of surgical site draining.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDescriptions of the traditional non-Enhanced Recovery After Surgery (ERAS) and ERAS protocols implemented in our department\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhase\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNon-ERAS\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eERAS\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePre-operative\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePatient blood management\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAnemia screening not systematic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSystematic anemia screening\u003c/p\u003e\u003cp\u003eSurgery delay if anemia with iron supplementation\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePatient counseling\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBy operating surgeon\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBy operating surgeon, anesthesiologist, dietitian\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003ePerioperative\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInduction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypnotics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePropofol/Sevoflurane\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePropofol TCI,\u003c/p\u003e\u003cp\u003eBIS monitoring\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCurarisation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNot systematic\u003c/p\u003e\u003cp\u003eIntubation with remifentanil\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNot systematic Intubation with remifentanil or atracurium if sedation with dexmedetomidine\u003c/p\u003e\u003cp\u003eTOF monitoring\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePain management\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLocoregional blocks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEcho-guided maxillary nerve block by anesthesiologist, mandibular vestibular infiltration with xyloca\u0026iuml;ne and adrenalin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSystematic echo-guided maxillary and mandibular nerves block by anesthesiologist\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMorphine TCI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSufentanil - remifentanil\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRemifentanil or OFA (dexmedetomidine)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNociception monitoring\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNot systematic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNOL\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePatient blood management\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTranexamic acid not systematic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSystematic tranexamic acid\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePONV prevention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDexamethasone Metoclopramid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDexamethasone\u003c/p\u003e\u003cp\u003eOFA\u003c/p\u003e\u003cp\u003eOndansetron\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAntalgics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eParacetamol, ketoprofen, +- nefopam\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eParacetamol, ketoprofen, +- nefopam\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003ePostoperative\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAntalgics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrescription by surgeon\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePrescription by anesthesiologist\u003c/p\u003e\u003cp\u003eMultimodal anesthesia with NSAIs\u003c/p\u003e\u003cp\u003eAdapted galenics\u003c/p\u003e\u003cp\u003ePatient counseling\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSDD failure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo or delayed oral feeding\u003c/p\u003e\u003cp\u003eTachycardia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo or delayed oral drinking\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIron supplementation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIntravenous iron supplementation if blood loss\u0026thinsp;\u0026gt;\u0026thinsp;500mL\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003eBIS: bispectral index; NOL: nociception level; NSAI: non-steroidal anti-inflammatory; OFA: opioid-free anesthesia; PONV: postoperative nausea and vomiting; SDD: same-day discharge; TCI: target-controlled infusion; TOF: train of four\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eData on participant demographics (age, sex, weight, height), surgery duration, surgery end time, procedures performed (e.g., Le Fort I osteotomy, mandibular osteotomy), postoperative complications, and early readmissions were collected from medical records.\u003c/p\u003e\n\u003ch3\u003eStudy outcomes\u003c/h3\u003e\n\u003cp\u003eOur primary study endpoint was the difference in rate of unplanned SDRs, which can also be described as unplanned next-day discharges or failed same-day discharges, between participants having undergone the ERAS versus non-ERAS protocols. Secondary study endpoints involved: (1) identifying independent variables associated with unplanned SDR, and (2) determining if ERAS status affected any associations found between independent variables and SDR.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analyses\u003c/h2\u003e\u003cp\u003eBased on our previous study indicating an SDR rate of 35% under traditional outpatient protocols [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] with an expected reduction to 20% under ERAS protocols, we calculated a target inclusion of 370 participants (185 in each group) to achieve 90% power at a 5% significance level using the free G*Power software version 3.1 (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.psychologie.hhu.de/arbeitsgruppen/allgemeine-psychologie-und-arbeitspsychologie/gpower\u003c/span\u003e\u003cspan address=\"https://www.psychologie.hhu.de/arbeitsgruppen/allgemeine-psychologie-und-arbeitspsychologie/gpower\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe characteristics of the cohort are described by frequencies and percentages (categorical variables) or means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) (continuous variables). Between non-ERAS and ERAS groups, the Chi-squared test was used to compare the rates of: (1) SDR, and (2) SDR according to osteotomy procedure type performed. Logistic regression analysis identified predictive factors associated with SDR. The independent variables tested were sex, preoperative age (continuous), surgery duration (continuous), surgery end time (continuous), osteotomy type, associated genioplasty, and whether the ERAS protocol was used. Odds ratios with p values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 in bivariate analyses were included in the multivariate model. We then performed an interaction analysis to assess whether ERAS status modified the associations between SDR and the same independent variables.\u003c/p\u003e\u003cp\u003eStatistical analyses were performed using the GraphPad Prism software version 10.0.0 (Boston, Massachusetts USA). The significance threshold was set to p-values\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003eCohort demographic and clinical characteristics\u003c/h2\u003e\u003cp\u003eA total of 511 participants having undergone orthognathic surgery between January 1 2015 and December 31 2022 in our tertiary maxillofacial surgery department were included for study. No patients were excluded. The mean age was 23.5\u0026thinsp;\u0026plusmn;\u0026thinsp;9.3 (13\u0026ndash;57) years and 56.7% of participants were female. Most participants were discharged on the same day (n\u0026thinsp;=\u0026thinsp;358/511; 70.0% participants) with an overall SDR rate of 30.0% for all surgeries combined. The mean surgery duration was 182\u0026thinsp;\u0026plusmn;\u0026thinsp;68.4 minutes and 50% of all procedures were completed by 13:04 PM for all surgeries combined. The majority of procedures performed were BSSOs (51.5%), followed by COs (27.8%) and then MOs (20.7%). Genioplasty was associated for approximately one-fourth (25.8%) of total participants. The non-ERAS protocol was followed by 212 (41.5%) participants and the ERAS protocol was followed by 299 (58.5%) participants. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e summarizes the demographic and clinical characteristics for the total cohort as well as for non-ERAS and ERAS groups. Note that surgery duration was +\u0026thinsp;18.7 minutes longer in the ERAS group (p\u0026thinsp;=\u0026thinsp;0.001) but surgery end time showed no difference between the non-ERAS (13:45 PM) and ERAS (13:23 PM) groups (p\u0026thinsp;=\u0026thinsp;0.29).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cb\u003eThe demographic and clinical characteristics for the total cohort as well as for the non-enhanced recovery after surgery (ERAS) and ERAS groups\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003cp\u003ecohort\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNon-ERAS group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eERAS\u003c/p\u003e\u003cp\u003egroup\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of participants, n (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e511\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e212 (41.5%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e299 (58.5%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale sex, n (% per group)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e290 (56.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e84 (39.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e137 (45.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23.5\u0026thinsp;\u0026plusmn;\u0026thinsp;9.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24.3\u0026thinsp;\u0026plusmn;\u0026thinsp;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22.9\u0026thinsp;\u0026plusmn;\u0026thinsp;8.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurgery duration (min), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e182,1\u0026thinsp;\u0026plusmn;\u0026thinsp;68.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e171.0\u0026thinsp;\u0026plusmn;\u0026thinsp;59.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e189.7\u0026thinsp;\u0026plusmn;\u0026thinsp;73.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurgery end time (24 hours), mean\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13:31 PM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13:45 PM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13:23 PM\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eType of procedure, n (% per group)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBilateral sagittal split\u0026nbsp;osteotomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e263 (51.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e106 (50%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e157 (52.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaxillary osteotomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e106 (20.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e48 (22.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e58 (19.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCombined osteotomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e142 (27.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e58 (27.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e84 (28.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAssociated genioplasty, n (% per group)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e132 (25.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e73 (34.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e59 (19.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSame-day readmission, n (% per group)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e153 (30.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e81 (38.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e72 (24.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eSD: standard deviation\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eThe effects of the Enhanced Recovery After Surgery Protocol on same-day readmission\u003c/h2\u003e\u003cp\u003eThe SDR rate was significantly higher for the non-ERAS (38.2%) versus the ERAS (24.1%) group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), corresponding to a relative reduction of 37% in SDR rate with ERAS implementation. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e depicts SDR rates according to both ERAS implementation and surgery procedure type.\u003c/p\u003e\u003cp\u003eThe specific SDR rates according to the type of surgery performed decreased with application of ERAS. BSSO had the lowest SDR rates among all the procedures, with a frequency of 17,5%. The ERAS group had a lower SDR rate than Non-ERAS group (14,1% vs. 22,6%). Maxillary osteotomy also had a lower SDR rate in the ERAS group than in the non-ERAS group (43.7% vs. 32.7%). However, these decreases were not statistically significant (respectively p\u0026thinsp;=\u0026thinsp;0.07 and p\u0026thinsp;=\u0026thinsp;0.24).\u003c/p\u003e\u003cp\u003eThe SDR rate for CO was significantly lower in the ERAS group than in the non-ERAS group (62.1% vs. 36.9%, p\u0026thinsp;=\u0026thinsp;0.002).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cb\u003eSame-day readmission rates for osteotomy procedure type performed according to Enhanced Recovery After Surgery (ERAS) protocol implementation or not\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSame-day readmission,\u003c/p\u003e\u003cp\u003en(% per group)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003cp\u003ecohort\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;511)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNon-ERAS group\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;212)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eERAS\u003c/p\u003e\u003cp\u003eGroup\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;299)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep value\u003csup\u003eA\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOsteotomy type\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAll types combined\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e153/511 (30.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e81/212 (38.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e72/299 (24.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ebilateral sagittal split osteotomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e46/263 (30.117.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e24/106 ( 2.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e22/157 (14.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaxillary osteotomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e40/106(37.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e21/46 (43.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e19/58 (32.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.24\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ecombined osteotomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e67/142(47.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e36/48 (62.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e31/84 (36.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003eA\u003c/sup\u003e: Chi-squared test\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003ePredictors of same-day readmission\u003c/h2\u003e\u003cp\u003eIn bivariate analyses (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e), later surgery end time (\u003csub\u003eadj\u003c/sub\u003eOR 1.2; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and slightly longer surgery duration (\u003csub\u003eadj\u003c/sub\u003eOR 1.004; p\u0026thinsp;=\u0026thinsp;0.008), associated genoplasty (\u003csub\u003eadj\u003c/sub\u003eOR 2.7; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), and both MO (\u003csub\u003eadj\u003c/sub\u003eOR 2.9; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and CO (\u003csub\u003eadj\u003c/sub\u003eOR 4.2; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) procedures were found positively associated with SDR. Conversely, ERAS protocol implementation was found negatively associated with SDR (\u003csub\u003eadj\u003c/sub\u003eOR 0.5; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Neither age (\u003csub\u003eadj\u003c/sub\u003eOR 0.99; p\u0026thinsp;=\u0026thinsp;0.61) nor sex (\u003csub\u003eadj\u003c/sub\u003eOR 1.0; p\u0026thinsp;=\u0026thinsp;0.81) were associated with SDR.\u003c/p\u003e\u003cp\u003eAfter adjustment for confounders in the multivariate analysis (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e), later surgery end time (\u003csub\u003eadj\u003c/sub\u003eOR 1.2; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), associated genoplasty (\u003csub\u003eadj\u003c/sub\u003eOR 2.1; =0.0013), and both MO (\u003csub\u003eadj\u003c/sub\u003eOR 2.6; p\u0026thinsp;=\u0026thinsp;0.0004) and notably CO (\u003csub\u003eadj\u003c/sub\u003eOR 4.1; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) procedures were found independently positively associated with SDR. ERAS protocol implementation was found independently negatively associated with SDR (\u003csub\u003eadj\u003c/sub\u003eOR 0.5; =0.004), indicating a 50% reduction in risk of SDR for participants in the ERAS group. The longer surgery duration association with SDR was not significant after adjustment.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTable 4: Bivariate and multivariate regression analysis results demonstrating the predictors of same-day readmission\u003c/strong\u003e\u003c/p\u003e\n\u003ctable id=\"Tab4\" border=\"1\"\u003e\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u003cimg 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\"\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003eA\u003c/sup\u003e: bilateral sagittal split osteotomy as reference; SDR: same-day readmission\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe effects of the Enhanced Recovery After Surgery Protocol on independent variables associated with same-day readmission\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter introducing ERAS implementation effects into the multivariate model (Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e), a significant interaction was observed between ERAS protocol implementation and CO (adjOR 0.39; p\u0026thinsp;=\u0026thinsp;0.039), indicating that the ERAS protocol reduced the risk of SDR among patients undergoing COs. Only non-significant trends toward a protective effect against SDR were noted for the interactions between ERAS and the other independent variables.\u003c/p\u003e\n\u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eInteraction analysis showing the effects of the Enhanced Recovery After Surgery (ERAS) protocol on the same independent variables associated with same-day readmission from Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eInteraction effect\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003csub\u003eadj\u003c/sub\u003eOR [95%CI]\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eERAS protocol\u0026thinsp;+\u0026thinsp;surgery duration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.97 [0.92\u0026ndash;1.01]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.126\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eERAS protocol\u0026thinsp;+\u0026thinsp;surgery end time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.86 [0.67\u0026ndash;1.11]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.251\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eERAS protocol\u0026thinsp;+\u0026thinsp;associated genioplasty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.56 [0.25\u0026ndash;1.26]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.161\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eERAS protocol\u0026thinsp;+\u0026thinsp;maxillary osteotomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.46 [0.20\u0026ndash;1.08]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.073\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eERAS protocol\u0026thinsp;+\u0026thinsp;combined osteotomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.39 [0.16\u0026ndash;0.95]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.039\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n"},{"header":"Discussion","content":"\u003cp\u003eWe evaluated the effectiveness and safety of our new ERAS protocol developed to promote outpatient orthognathic surgery. Overall, we demonstrate a significant reduction in SDR rates from 38.2% for participants having undergone the traditional non-ERAS surgical protocol to 24.1% for the ERAS protocol (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with reduced SDR significantly associated with surgeries via ERAS protocol implementation (\u003csub\u003eadj\u003c/sub\u003eOR 0.5 [0.3\u0026ndash;0.8]; p\u0026thinsp;=\u0026thinsp;0.004). These findings align with recent literature on fast-track and ERAS pathways in orthognathic surgery, which consistently report improvements in patient safety, discharge rates, and reduced opioid consumption.\u003c/p\u003e\u003cp\u003eOur regression analyses for identification of potential risk factors and ERAS interactions associated with increased SDR indicated us how ERAS affected outpatient strategy success. Firstly, neither age nor sex were associated with higher rates of SDR in bivariate analyses. Participants undergoing surgery later in the day had a higher risk for SDR (\u003csub\u003eadj\u003c/sub\u003eOR 1.2 [1.1\u0026ndash;1.3]; p\u0026thinsp;\u0026gt;\u0026thinsp;0.001). The interaction study did not show a significant change in this association after ERAS protocol implementation (\u003csub\u003eadj\u003c/sub\u003eOR 0.86 [0.67\u0026ndash;1.11]; p\u0026thinsp;=\u0026thinsp;0.251). We did however reveal a slight significant increase of approximately 19 minutes in surgical duration after ERAS protocol implementation. Interestingly, this rise could be attributed to more comprehensive perioperative assessments and adherence to protocol-related workflows that aim to optimize outcomes rather than accelerate discharge. The systematic use of echo-guided anesthesiologic blocks of maxillary and/or mandibular nerves could also underlie longer surgery durations.\u003c/p\u003e\u003cp\u003eIn our study, CO (\u003csub\u003eadj\u003c/sub\u003eOR 4.1 [2.5\u0026ndash;6.8]; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), and to a lesser extent MO (\u003csub\u003eadj\u003c/sub\u003eOR 2.6 [1.5\u0026ndash;4.4]; p\u0026thinsp;=\u0026thinsp;0.0004), were associated with a higher risk of SDR compared to BSSO. However, interaction analysis \u0026ndash; assessing how application of the ERAS protocol affected these associations between SDR and surgery type \u0026ndash; showed a substantial reduction in approximately two-thirds in the association between SDR and CO (\u003csub\u003eadj\u003c/sub\u003eOR 0.38 [0.17\u0026ndash;0.95]; p\u0026thinsp;=\u0026thinsp;0.039). Thus, application of the ERAS protocol allowed for the performance of this more invasive surgery without an increased risk of complications. Ferrara et al. [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] showed that an ERAS protocol increased same-day discharge after bimaxillary procedures while decreasing opioid use, supporting the concept that structured perioperative care can make even complex surgeries feasible in an outpatient setting. The same interaction effect was not significant for the association between SDR and MO (\u003csub\u003eadj\u003c/sub\u003eOR 0.46 [0.20\u0026ndash;1.08]; p\u0026thinsp;=\u0026thinsp;0.073). This could be explained by the absence of mandibular nerve block in isolated genioplasty without ramic osteotomy, with genioplasty also found associated with increased risk of SDR (\u003csub\u003eadj\u003c/sub\u003eOR 2.1 [1.3\u0026ndash;3.3]; p\u0026thinsp;=\u0026thinsp;0.0013). In all, these findings indicate that more complex procedures can be transitioned to outpatient care but require careful consideration [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], such as systematic mandibular blocks when feasible, intensified airway and edema monitoring, high-risk antiemetic prophylaxis, or structured home-care instructions. These findings collectively allow for a more precise definition of how to manage and promote outpatient strategies that are currently rarely performed in France [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Indeed, the authors declare that only 40% of surgeons apply fast-track strategies in the orthognathic field, mostly for Surgically assisted Rapid Palatal Expansion (SARPE), and that 92.3% required a 1\u0026ndash;2 day hospital stay after BSSO and 86.5% after CO. In all, we show that our outpatient strategy with ERAS for BSSO, MO and CO is safe, with commonly considered risk factors, such as age, not being likely to influence SDR rates.\u003c/p\u003e\u003cp\u003eFrom a medico-economic point-of-view, these results are encouraging for the consideration of shorter and yet safe hospital stays. Venugoplan et al. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] have shown that patients undergoing orthognathic surgery had a mean hospital stay of 2.95 days, representing 30,580 days for 10,345 interventions. Shifting to a more \u0026Prime;outpatient-oriented\u0026Prime; paradigm could drastically reduce associated hospital stays, liberating hospital beds for other patients, thus limiting the risk of nosocomial infections and diminishing associated costs.\u003c/p\u003e\u003cp\u003eSeveral study limitations must be acknowledged. Firstly, the retrospective nature of this cohort study means reliance on existing medical records, which could have resulted in inconsistencies in data collection and reporting practices. Furthermore, our study focused exclusively on a single center, limiting the generalizability of the results to broader clinical settings. Indeed, variability in patient demographics, surgical techniques, or protocols across different healthcare systems could yield different outcomes. Multicentric studies are therefore needed to validate our findings. Additionally, while the study examined certain predictors of readmission, it did not account for all possible confounding factors, such as psychological enthusiasm and socio-economic status; factors that can considerably impact both recovery and patient satisfaction after surgery [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. These are shared with many prior fast-track studies [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Future steps should therefore include multicenter prospective studies, development of a national ERAS registry for orthognathic surgery, and integration of patient-centered outcomes (e.g., QoR-15, satisfaction, anxiety). Lastly, the relatively short postoperative follow-up period may not adequately capture long-term outcomes or the full spectrum of potential complications associated with outpatient orthognathic procedures, necessitating further longitudinal studies to comprehensively evaluate the effectiveness and safety of ERAS methodologies [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Ongoing research into the optimization of postoperative care will be essential to further refine these protocols and address outcomes across various populations.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eWe found a significant reduction in the rate of SDR among participants having undergone the ERAS protocol (24.1%) versus the traditional protocol (38.2%), with a 50% reduction in risk of SDR for participants with ERAS implementation (\u003csub\u003eadj\u003c/sub\u003eOR 0.5; p\u0026thinsp;=\u0026thinsp;0.004). The ERAS protocol resulted in a significantly longer mean surgery duration (+\u0026thinsp;19 minutes) and was most beneficial for reducing SDR for more complex combined orthognathic surgeries. The findings underscore the promising effects of implementing our ERAS protocol in outpatient orthognathic surgery. Our results also emphasize the need for tailored approaches in patient selection and management, particularly when addressing older outpatient candidates or those lacking an internal caregiver. Finally, future studies should explore the sustainability of these results over longer follow-up periods and assess the cost-effectiveness of these protocols within diverse healthcare systems.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank Jacqueline Butterworth, PhD (Toulouse University Hospital) for help with manuscript drafting and language.\u0026nbsp;\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthics and consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures performed were part of routine care, and both in accordance with institutional guidelines and with the tenets of the 1964 Helsinki Declaration. Ethical approval was waived by the IRB of Toulouse University Hospital given the retrospective and non-interventional nature of the study as asserted by the French Jard\u0026eacute; Ethical and Regulatory Law. All participants or their relatives received clear written information and gave free and written informed consent to participate. All data have been anonymized for publication.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSamy Bencherqui: study conception and design, data acquisition and interpretation, manuscript drafting and revising;\u0026nbsp;Fr\u0026eacute;d\u0026eacute;ric Lauwers: data\u0026nbsp;analysis and interpretation, manuscript revising;\u0026nbsp;Marion Mure:\u0026nbsp;data acquisition and manuscript revising; Rapha\u0026euml;l Costes: data acquisition and manuscript revising;\u0026nbsp;H\u0026eacute;lios Bertin: data interpretation and\u0026nbsp;manuscript revising;\u0026nbsp;Pierre Corre: data interpretation and\u0026nbsp;manuscript revising;\u0026nbsp;Alice Prevost:\u0026nbsp;study conception, design, and supervision, data analysis and interpretation, manuscript revising.\u0026nbsp;Samy Bencherqui\u0026nbsp;wrote the first article version, and all authors have approved the final version of the manuscript and agree to be accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe original participant data analyzed in this study are available from the corresponding author on reasonable request and after approval for data transfer by the IRB of Toulouse University Hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received for this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone of the authors have any conflicts to declare. \u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGarg M, Cascarini L, Coombes DM, et al (2010) Multicentre study of operating time and inpatient stay for orthognathic surgery. Br J Oral Maxillofac Surg 48:360\u0026ndash;363. https://doi.org/10.1016/j.bjoms.2009.08.035\u003c/li\u003e\n\u003cli\u003ePr\u0026eacute;vost A, Lauwers F, Varazzani A, et al (2023) Outpatient Orthognathic Surgery: A Prospective Study of Predictive Factors for the Length of Hospital Stays. Clinical Oral Investigations. https://doi.org/10.1007/s00784-023-05290-x\u003c/li\u003e\n\u003cli\u003eHattori Y, Uda H, Niu A, et al (2023) Ambulatory sagittal split ramus osteotomy: strategy for enhanced recovery after surgery. International Journal of Oral and Maxillofacial Surgery 52:476\u0026ndash;480. https://doi.org/10.1016/j.ijom.2022.08.015\u003c/li\u003e\n\u003cli\u003eMommaerts MY, Otero JJ, Detriche O (2017) Fast-Track Orthognathic Surgery: An Evidence-Based Review. Annals of Maxillofacial Surgery. https://doi.org/10.4103/ams.ams_106_17\u003c/li\u003e\n\u003cli\u003eFerrara JT, Tehrany GM, Chen Q, et al (2022) Evaluation of an Enhanced Recovery After Surgery Protocol (ERAS) for Same-Day Discharge and Reduction of Opioid Use Following Bimaxillary Orthognathic Surgery. Journal of Oral and Maxillofacial Surgery. https://doi.org/10.1016/j.joms.2021.07.002\u003c/li\u003e\n\u003cli\u003eMuller S, Zalunardo MP, Hubner M, et al (2009) A fast-track program reduces complications and length of hospital stay after open colonic surgery. Gastroenterology 136:842\u0026ndash;847. https://doi.org/10.1053/j.gastro.2008.10.030\u003c/li\u003e\n\u003cli\u003eNicholson A, Lowe MC, Parker J, et al (2014) Systematic review and meta-analysis of enhanced recovery programmes in surgical patients. Br J Surg 101:172\u0026ndash;188. https://doi.org/10.1002/bjs.9394\u003c/li\u003e\n\u003cli\u003eLopez CD, River Perla KM, Njoroge MW, et al (2023) Risk Assessments in Orthognathic Surgery: A National Inpatient Sample (NIS) and Nationwide Ambulatory Surgery Sample (NASS) Analysis. Face. https://doi.org/10.1177/27325016221146425\u003c/li\u003e\n\u003cli\u003eHsu SS-P, Gateno J, Bell RB, et al (2013) Accuracy of a Computer-Aided Surgical Simulation (CASS) Protocol for Orthognathic Surgery: A Prospective Multicenter Study. J Oral Maxillofac Surg 71:128\u0026ndash;142. https://doi.org/10.1016/j.joms.2012.03.027\u003c/li\u003e\n\u003cli\u003eChen C, Sun N, Jiang C, Sun J (2021) Randomized Controlled Clinical Trial to Assess the Utility of Computer-Aided Intraoperative Navigation in Bimaxillary Orthognathic Surgery. Journal of Craniofacial Surgery. https://doi.org/10.1097/scs.0000000000007512\u003c/li\u003e\n\u003cli\u003eB\u0026auml;r A-K, Werkmeister R, Dort JC, Al-Nawas B (2024) Perioperative care in orthognathic surgery - A systematic review and meta-analysis for enhanced recovery after surgery. Journal of Cranio-Maxillofacial Surgery 52:1244\u0026ndash;1258. https://doi.org/10.1016/j.jcms.2024.08.014\u003c/li\u003e\n\u003cli\u003eAlvarez GA, Hebert KJ, Britt MC, et al (2024) An Enhanced Recovery After Surgery (ERAS) Protocol for Orthognathic Surgery Reduces Rates of Postoperative Nausea. Journal of Craniofacial Surgery 35:1125\u0026ndash;1128. https://doi.org/10.1097/SCS.0000000000010121\u003c/li\u003e\n\u003cli\u003ePhillips C, Brookes CD, Rich J, et al (2015) Postoperative nausea and vomiting following orthognathic surgery. International Journal of Oral and Maxillofacial Surgery 44:745\u0026ndash;751. https://doi.org/10.1016/j.ijom.2015.01.006\u003c/li\u003e\n\u003cli\u003eBrookes CD, Berry J, Rich J, et al (2015) Multimodal Protocol Reduces Postoperative Nausea and Vomiting in Patients Undergoing Le Fort I Osteotomy. Journal of Oral and Maxillofacial Surgery 73:324\u0026ndash;332. https://doi.org/10.1016/j.joms.2014.08.007\u003c/li\u003e\n\u003cli\u003ePekkari C, Lund B, Davidson T, et al (2024) Cost analysis of orthognathic surgery: outpatient care versus inpatient care. International Journal of Oral and Maxillofacial Surgery 53:829\u0026ndash;835. https://doi.org/10.1016/j.ijom.2024.02.005\u003c/li\u003e\n\u003cli\u003eOlate S, Sigua E, Asprino L, De Moraes M (2018) Complications in Orthognathic Surgery. Journal of Craniofacial Surgery 29:e158\u0026ndash;e161. https://doi.org/10.1097/SCS.0000000000004238\u003c/li\u003e\n\u003cli\u003eEsquerr\u0026eacute; T, Mure M, Minville V, et al (2024) Bilateral ultrasound-guided maxillary and mandibular combined nerves block reduces morphine consumption after double-jaw orthognathic surgery: a randomized controlled trial. Reg Anesth Pain Med rapm-2024-105497. https://doi.org/10.1136/rapm-2024-105497\u003c/li\u003e\n\u003cli\u003eVanden Haute N, Bach E, Bouletreau P, et al (2025) An updated overview of orthognathic surgery practices in France. Journal of Stomatology, Oral and Maxillofacial Surgery 126:102210. https://doi.org/10.1016/j.jormas.2024.102210\u003c/li\u003e\n\u003cli\u003eVenugoplan SR, Nanda V, Turkistani K, et al (2012) Discharge patterns of orthognathic surgeries in the United States. J Oral Maxillofac Surg 70:e77-86. https://doi.org/10.1016/j.joms.2011.09.030\u003c/li\u003e\n\u003cli\u003eDavies LA, Crawford EMS, Jones JL, Jones SD (2018) Day-case bilateral sagittal split osteotomy. British Journal of Oral and Maxillofacial Surgery 56:968\u0026ndash;971. https://doi.org/10.1016/j.bjoms.2018.09.012\u003c/li\u003e\n\u003cli\u003eTorres KV, Pessoa LS, Luna AHB, Alves G\u0026Acirc;DS (2017) Quality of life after orthognathic surgery: a case report. Rev CEFAC 19:733\u0026ndash;739. https://doi.org/10.1590/1982-021620171957517\u003c/li\u003e\n\u003cli\u003eOliveira ZSBD, Silveira MLMD, Gomes PP, et al (2021) Early recovery after surgery protocol in orthognathic surgery: a randomized, blind clinical study. Braz oral res 35:e87. https://doi.org/10.1590/1807-3107bor-2021.vol35.0087\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"clinical-oral-investigations","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cloi","sideBox":"Learn more about [Clinical Oral Investigations](http://link.springer.com/journal/784)","snPcode":"784","submissionUrl":"https://submission.nature.com/new-submission/784/3","title":"Clinical Oral Investigations","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Orthognathic surgery, Enhanced Recovery After Surgery Protocol, Same-day readmission, Outpatient, Fast-track","lastPublishedDoi":"10.21203/rs.3.rs-7453620/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7453620/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjectives\u003c/h2\u003e\u003cp\u003eWe aimed to evaluate how a newly implemented Enhanced Recovery After Surgery (ERAS) protocol affected same-day discharge after orthognathic surgery.\u003c/p\u003e\u003ch2\u003eMaterials and Methods\u003c/h2\u003e\u003cp\u003e A retrospective, cohort study was performed on participants having undergone orthognathic surgery between 2015 and 2022 in our tertiary French department either via the former traditional non-ERAS or new ERAS protocol. The primary study endpoint was difference in unplanned same-day readmission (SDR) rates between protocol types. Multivariate logistic regression was used to identify predictors of SDR.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA total of 511 participants were included: n\u0026thinsp;=\u0026thinsp;212(41.5%) followed the non-ERAS protocol and n\u0026thinsp;=\u0026thinsp;299(58.5%) the ERAS protocol. SDR was significantly higher in the non-ERAS group (38.2%) compared to the ERAS group (24.1%) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), corresponding to a 37% relative reduction in SDR. In multivariate analysis, later surgery end time (\u003csub\u003eadj\u003c/sub\u003eOR 1.2, 95%CI 1.1\u0026ndash;1.3; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), associated genioplasty (\u003csub\u003eadj\u003c/sub\u003eOR 2.1, 95%CI 1.3\u0026ndash;3.3; p\u0026thinsp;=\u0026thinsp;0.0013), maxillary osteotomy (\u003csub\u003eadj\u003c/sub\u003eOR 2.6, 95%CI 1.5\u0026ndash;4.4; p\u0026thinsp;=\u0026thinsp;0.0004), and combined osteotomy (\u003csub\u003eadj\u003c/sub\u003eOR 4.1, 95%CI 2.5\u0026ndash;6.8; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) were independently associated with higher SDR. Conversely, ERAS protocol implementation remained protective (\u003csub\u003eadj\u003c/sub\u003eOR 0.5, 95%CI 0.3\u0026ndash;0.8; p\u0026thinsp;=\u0026thinsp;0.004). Interaction analysis demonstrated that ERAS protocol implementation significantly reduced the risk of SDR among patients undergoing combined osteotomy (\u003csub\u003eadj\u003c/sub\u003eOR 0.39, 95%CI 0.16\u0026ndash;0.95; p\u0026thinsp;=\u0026thinsp;0.039).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eERAS protocol implementation reduced the risk of SDR with the greatest benefit observed for complex combined osteotomies.\u003c/p\u003e\u003ch2\u003eClinical Relevance\u003c/h2\u003e\u003cp\u003eThese findings support our ERAS protocol as a safe and effective for promoting outpatient orthognathic surgery, particularly in reducing complications after complex procedures.\u003c/p\u003e","manuscriptTitle":"Reduction in same-day readmission rate for orthognathic surgery with a new Enhanced Recovery After Surgery protocol","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-01 07:51:13","doi":"10.21203/rs.3.rs-7453620/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-13T08:33:25+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-20T12:13:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"244410199094030823351759324105189127506","date":"2025-11-04T15:28:59+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-04T15:12:41+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-26T07:19:38+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-26T07:18:28+00:00","index":"","fulltext":""},{"type":"submitted","content":"Clinical Oral Investigations","date":"2025-08-25T11:56:36+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"clinical-oral-investigations","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cloi","sideBox":"Learn more about [Clinical Oral Investigations](http://link.springer.com/journal/784)","snPcode":"784","submissionUrl":"https://submission.nature.com/new-submission/784/3","title":"Clinical Oral Investigations","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"97d82b73-db44-4aab-8234-f2327d49fe1c","owner":[],"postedDate":"September 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-15T12:24:14+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-01 07:51:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7453620","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7453620","identity":"rs-7453620","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}