ABSTRACT
Introduction/Aims: Historically orthognathic patients have required overnight admission owing to airway risk, risk of bleeding, pain, nausea and vomiting. (1) More recently patient drivers, NHS pressures, improved anaesthesia and operator efficiency (2) have led us to look for ways to deliver the service on a daycare protocol.(3) Material(s) and Method(s): We proposed a single surgeon pilot study in line with governance and safety standards. Peri operative criteria were defined as ASA1/2, support at home, standardised pre, intra and post operative medication and a set anaesthetic technique. Surgical parameters were set as a Le Fort 1 or BSSO osteotomy with intra operative wafers and post operative orthodontic review available. A prospective study from August 2017 to August 2021 was carried out. Results/Statistics: 35 patients met the criteria, 15 were treated on the day case protocol. 4 patients were excluded for surgical complications and 3 reported they would not have coped at home. 8 were successfully managed on the pathway. Barriers to the study included covid-19 restrictions, mixed elective and emergency operating, delays to theatre and patient acceptance varied. Conclusions/Clinical Relevance: Single jaw day case orthognathic surgery may increase productivity and reduce cancellations on the day. A successful pathway depends on good nursing, anaesthetic and orthodontic support. We report our experience of a pilot pathway and present our written protocols for each discipline. Managing patient selection and expectations is critical. Copyright © 2022
ABSTRACT
Introduction: UK OMFS training means that the time between completing training and reaching retirement age is short. Mean retirement age is 59.6 years for UK doctors giving the average OMFS consultant approximately 20 years of practice. Current pension tax regulations, new consultant posts having 10 session job plans, increasing proportion of female specialists and backlog of elective care created by COVID-19 may create a significant gap between workforce and work needed. Methods: The age of current OMFS consultants was estimated using the date of their primary medical/dental qualification, changes in job plans using data from the BAOMS Workforce Census and from job-plans of recently advertised posts and unfilled posts from Regional Specialty Professional Advisors (RSPAs). Results: First degree dates were identified for 476 OMFS substantive consultant posts. Estimated average age was 52.7 years (minimum 35.9, maximum 72.1), 75th centile age 59.0 with 23% of the current workforce above the average retirement age for doctors. New consultant posts were all 10 sessions (40 hours), whereas existing consultants average 12.1 sessions. Current vacancies are summarised here: Conclusions: A significant number of the OMFS consultant workforce is above the average retirement age. Loss of senior colleagues from the workforce if added to differences between existing and new job plans and a higher proportion of female specialists may require both increasing number of specialty training posts and more effective recruitment.