Evaluation of an Enhanced Recovery After Surgery Protocol (ERAS) for Same-Day Discharge and Reduction of Opioid Use Following Bimaxillary Orthognathic Surgery

Abstract

This study sought to evaluate the impact of implementation of a comprehensive enhanced recovery after surgery (ERAS) protocol upon patients undergoing maxillary and mandibular osteotomy (MMO). This study was a retrospective, observational study of patients undergoing MMO. The study intervention group consisted of patients who underwent MMO with utilization of ERAS protocol compared to control group without ERAS. The primary outcome measure was same-day discharge. Secondary outcome measures included hospital length-of-stay (LOS), overall dose of opioids administered, total operating room time, estimated blood loss, need for hospital admission, and complications. Descriptive statistics and multivariable analysis were computed and theP value was set at .05. We compared 189 patients who underwent MMO with and without genioplasty and received a comprehensive surgical and multimodal analgesic regimen to 170 control patients who underwent MMO with or without genioplasty without receiving the above protocol. There was a statistically significant decrease in hospital admission post-surgery (83.5% - control vs 22.2% - intervention) and in overall hospital length-of-stay in the intervention group. There was no change in the overall operating room time, but there was a decrease in blood loss in the intervention group. The results suggest that use of a comprehensive ERAS protocol for patients undergoing MMO will decrease hospital length-of-stay without an increase in readmissions or complications. Future studies are needed to evaluate if pain scores, postoperative nausea and vomiting, and other complications differed when using a ERAS protocol.