Developing a patient pathway for day case single jaw Orthognathic Surgery in a regional hub

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