Skip to main content

Advertisement

SpringerLink
Log in

Operative time, blood loss, hemoglobin drop, blood transfusion, and hospital stay in orthognathic surgery

  • Original Article
  • Published:
Oral and Maxillofacial Surgery Aims and scope Submit manuscript

Abstract

Purpose

This study was conducted to evaluate the operative time, blood loss, hemoglobin drop, blood transfusion, and length of hospital stay in orthognathic surgery.

Methods

A 10-year retrospective analysis was performed on patients who underwent bilateral sagittal split osteotomy (with or without genioplasty), Le Fort I osteotomy (with or without genioplasty), or any combination of these procedures. A total of 271 patients were included.

Results

The age range was 17 to 49 years, with a mean age of 24.13 ± 4.51 years. Approximately 62% of patients underwent double-jaw surgery. The most common procedure was bilateral sagittal split with Le Fort I (37%). The average operative time was 3.96 ± 1.25 h. The mean estimated blood loss was 345.2 ± 149.74 mL. Approximately 9% of patients received intraoperative blood transfusion. The mean hemoglobin drop in the non-transfusion cases was 2.38 ± 0.89 g/dL. The mean postoperative hospital stay was 1.85 ± 0.83 days. Only one patient was admitted to the ICU for one night.

Conclusions

In orthognathic surgery, blood loss is relatively minor, blood transfusion is frequent, and ICU admission is unlikely. Operative time, blood loss, blood transfusion, and the complexity of the surgical procedure can significantly increase the length of hospital stay. Males may bleed more than females in orthognathic surgery. Hemoglobin drop can be overestimated due to hemodilution in orthognathic surgery, which may influence the decision to use blood transfusion.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. American Association of Oral and Maxillofacial Surgereons (2015) AAOMS criteria for orthognatic surgery 1–6. Accessed 17 Feb 2017

  2. Aziz SR (2004) Simon P. Hullihen and the origin of orthognathic surgery. J Oral Maxillofac Surg 62:1303–1307. doi:10.1016/j.joms.2003.08.044

    Article  PubMed  Google Scholar 

  3. Venugoplan SR, Nanda V, Turkistani K et al (2012) Discharge patterns of orthognathic surgeries in the United States. J Oral Maxillofac Surg 70:e77–e86. doi:10.1016/j.joms.2011.09.030

    Article  PubMed  Google Scholar 

  4. Kim SG, Park SS (2007) Incidence of complications and problems related to orthognathic surgery. J Oral Maxillofac Surg 65:2438–2444. doi:10.1016/j.joms.2007.05.030

    Article  PubMed  Google Scholar 

  5. Steel BJ, Cope MR (2012) Unusual and rare complications of orthognathic surgery: a literature review. J Oral Maxillofac Surg 70:1678–1691. doi:10.1016/j.joms.2011.05.010

    Article  PubMed  Google Scholar 

  6. Rummasak D, Apipan B, Kaewpradup P (2011) Factors that determine intraoperative blood loss in bimaxillary osteotomies and the need for preoperative blood preparation. J Oral Maxillofac Surg 69:e456–e460. doi:10.1016/j.joms.2011.02.085

    Article  PubMed  Google Scholar 

  7. Rodrigo C (1995) Induced hypotension during anesthesia with special reference to orthognathic surgery. Anesth Prog 42:41–58

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Piñeiro-Aguilar A, Somoza-Martín M, Gandara-Rey JM, García-García A (2011) Blood loss in orthognathic surgery: a systematic review. J Oral Maxillofac Surg 69:885–892. doi:10.1016/j.joms.2010.07.019

    Article  PubMed  Google Scholar 

  9. Murphy MF, Wallington TB, Kelsey P et al (2001) Guidelines for the clinical use of red cell transfusions. Br J Haematol 113:24–31. doi:10.1046/j.1365-2141.2001.02701.x

    Article  CAS  PubMed  Google Scholar 

  10. Shetty V, Sriram G (2015) Effectiveness of intravenous haemocoagulase on haemorrhage control in bi-maxillary orthognathic surgery—a prospective, randomised, controlled, double-blind study. J Cranio-Maxillofacial Surg 43:2000–2003. doi:10.1016/j.jcms.2015.08.032

    Article  Google Scholar 

  11. Schaberg SJ, Kelly JF, Terry BC et al (1976) Blood loss and hypotensive anesthesia in oral-facial corrective surgery. J Oral Surg 34:147–156

    CAS  PubMed  Google Scholar 

  12. Posnick J (2014) Orthognatic surgery: principles & practice. Elsevier Saunders, p 309

  13. Ervens J, Marks C, Hechler M et al (2010) Effect of induced hypotensive anaesthesia vs isovolaemic haemodilution on blood loss and transfusion requirements in orthognathic surgery: a prospective, single-blinded, randomized, controlled clinical study. Int J Oral Maxillofac Surg 39:1168–1174. doi:10.1016/j.ijom.2010.09.003

    Article  CAS  PubMed  Google Scholar 

  14. Praveen K, Narayanan V, Muthusekhar MR, Baig MF (2001) Hypotensive anaesthesia and blood loss in orthognathic surgery: a clinical study. Br J Oral Maxillofac Surg 39:138–140. doi:10.1054/bjom.2000.0593

    Article  CAS  PubMed  Google Scholar 

  15. Choi WS, Samman N (2008) Risks and benefits of deliberate hypotension in anaesthesia: a systematic review. Int J Oral Maxillofac Surg 37:687–703. doi:10.1016/j.ijom.2008.03.011

    Article  CAS  PubMed  Google Scholar 

  16. Choi WS, Irwin MG, Samman N (2009) The effect of tranexamic acid on blood loss during orthognathic surgery: a randomized controlled trial. J Oral Maxillofac Surg 67:125–133. doi:10.1016/j.joms.2008.08.015

    Article  PubMed  Google Scholar 

  17. Eftekharian H, Vahedi R, Karagah T, Tabrizi R (2015) Effect of tranexamic acid irrigation on perioperative blood loss during orthognathic surgery: a double-blind, randomized controlled clinical trial. J Oral Maxillofac Surg 73:129–133. doi:10.1016/j.joms.2014.07.033

    Article  PubMed  Google Scholar 

  18. Guyuron B, Vaughan C, Schlecter B (1996) The role of DDAVP (desmopressin) in orthognathic surgery. Ann Plast Surg 37:516–519. doi:10.1097/00000637-199611000-00010

    Article  CAS  PubMed  Google Scholar 

  19. de Lange J, Baas EM, Horsthuis RBG, Booij A (2008) The effect of nasal application of cocaine/adrenaline on blood loss in Le Fort I osteotomies. Int J Oral Maxillofac Surg 37:21–24. doi:10.1016/j.ijom.2007.07.017

    Article  PubMed  Google Scholar 

  20. Habler O, Schwenzer K, Zimmer K et al (2004) Effects of standardized acute normovolemic hemodilution on intraoperative allogeneic blood transfusion in patients undergoing major maxillofacial surgery. Int J Oral Maxillofac Surg 33:467–475. doi:10.1016/j.ijom.2003.10.007

    Article  CAS  PubMed  Google Scholar 

  21. Tang ZL, Wang X, Yi B et al (2009) Effects of the preoperative administration of Yunnan Baiyao capsules on intraoperative blood loss in bimaxillary orthognathic surgery: a prospective, randomized, double-blind, placebo-controlled study. Int J Oral Maxillofac Surg 38:261–266. doi:10.1016/j.ijom.2008.12.003

    Article  PubMed  Google Scholar 

  22. Stewart A, Newman L, Sneddon K, Harris M (2001) Aprotinin reduces blood loss and the need for transfusion in orthognathic surgery. Br J Oral Maxillofac Surg 39:365–370. doi:10.1054/bjom.2001.0664

    Article  CAS  PubMed  Google Scholar 

  23. Politano N, Jaskolka M, Blakey G et al (2012) The effect of preoperative recombinant erythropoietin on postoperative hematocrit level after orthognathic surgery. J Oral Maxillofac Surg 70:625–630. doi:10.1016/j.joms.2012.07.021

    Article  Google Scholar 

  24. Landes CA, Stübinger S, Rieger J et al (2008) Critical evaluation of piezoelectric osteotomy in orthognathic surgery: operative technique, blood loss, time requirement, nerve and vessel integrity. J Oral Maxillofac Surg 66:657–674. doi:10.1016/j.joms.2007.06.633

    Article  PubMed  Google Scholar 

  25. Olsen JJ, Skov J, Ingerslev J et al (2016) Prevention of bleeding in orthognathic surgery—a systematic review and meta-analysis of randomized controlled trials. J Oral Maxillofac Surg 74:139–150. doi:10.1016/j.joms.2015.05.031

    Article  PubMed  Google Scholar 

  26. Mangano DT, Tudor IC, Dietzel C (2006) The risk associated with aprotinin in cardiac surgery. N Engl J Med 354:353–365. doi:10.1056/NEJMoa051379

    Article  CAS  PubMed  Google Scholar 

  27. Schneeweiss S, Seeger JD, Landon J, Walker AM (2008) Aprotinin during coronary-artery bypass grafting and risk of death. New Engl J 358:771–783. doi:10.1056/NEJMoa0707571

    Article  CAS  Google Scholar 

  28. Huaman ET, Juvet LM, Nastri A et al (2008) Changing patterns of hospital length of stay after orthognathic surgery. J Oral Maxillofac Surg 66:492–497. doi:10.1016/j.joms.2007.08.025

    Article  PubMed  Google Scholar 

  29. Lupori JP, Van Sickels JE, Holmgreen WC (1997) Outpatient orthognathic surgery: review of 205 cases. J Oral Maxillofac Surg 55:558–563. doi:10.1016/S0278-2391(97)90483-3

    Article  CAS  PubMed  Google Scholar 

  30. Farrell BB, Tucker MR (2014) Orthognathic surgery in the office setting. Oral Maxillofac Surg Clin North Am 26:611–620. doi:10.1016/j.coms.2014.08.009

    Article  PubMed  Google Scholar 

  31. Varol A, Basa S, Ozturk S (2010) The role of controlled hypotension upon transfusion requirement during maxillary downfracture in double-jaw surgery. J Cranio-Maxillofacial Surg 38:345–349. doi:10.1016/j.jcms.2009.10.012

    Article  Google Scholar 

  32. Yu CNF, Chow TK, Kwan ASK et al (2000) Intra-operative blood loss and operating time in orthognathic surgery using induced hypotensive general anaesthesia: prospective study. Hong Kong Med J 6:307–311

    CAS  PubMed  Google Scholar 

  33. Posnick JC, Choi E, Chavda A (2016) Operative time, airway management, need for blood transfusions, and in-hospital stay for bimaxillary, intranasal, and osseous genioplasty surgery: current clinical practices. J Oral Maxillofac Surg 74:590–600. doi:10.1016/j.joms.2015.07.026

    Article  PubMed  Google Scholar 

  34. Devlin H, Horner K, Ledgerton D (1998) A comparison of maxillary and mandibular bone mineral densities. J Prosthet Dent 79:446–453

    Article  Google Scholar 

  35. DeConde AS, Soler ZM (2016) Chronic rhinosinusitis: epidemiology and burden of disease. Am J Rhinol Allergy 30:134–139. doi:10.2500/ajra.2016.30.4297

    Article  PubMed  Google Scholar 

  36. Mayrovitz HN, Regan MB (1993) Gender differences in facial skin blood perfusion during basal and heated conditions determined by laser Doppler flowmetry. Microvasc Res 45:211–218. doi:10.1006/mvre.1993.1019

    Article  CAS  PubMed  Google Scholar 

  37. American Society of Plastic Surgeons Men and Plastic Surgery: Male-Specific Considerations. http://www.plasticsurgery.org/cosmetic-procedures/men-and-plastic-surgery?sub=The+surgery#section-title. Accessed 17 Feb 2017

  38. Faverani LP, Ramalho-Ferreira G, Fabris ALS et al (2014) Intraoperative blood loss and blood transfusion requirements in patients undergoing orthognathic surgery. Oral Maxillofac Surg 18:305–310. doi:10.1007/s10006-013-0415-4

    Article  PubMed  Google Scholar 

  39. Chen C-M, Lai SS-T, Hsu K-J et al (2011) Assessment of the related factors of blood loss and blood ingredients among patients under hypotensive anesthesia in orthognathic surgery. J Craniofac Surg 22:1594–1597. doi:10.1097/SCS.0b013e31822e5edb

    Article  PubMed  Google Scholar 

  40. Billett H (1990) Hemoglobin and hematocrit. In: Clin. Methods Hist. Phys. Lab. Exam. 3rd edn. Butterworths, p 718–719

Download references

Acknowledgements

We would like to thank Dr. Ashwin Shetty for his tremendous help with the statistical analysis.

Author information

Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, Riyadh Colleges of Dentistry and Pharmacy, P.O. Box 84891, Riyadh, 11681, Saudi Arabia

    Ra’ed Ghaleb Salma

  2. Department of Oral and Maxillofacial Surgery, King Khalid General Hospital, Hafar Al-Batin, Saudi Arabia

    Fahad Mohammed Al-Shammari

  3. Department of Oral and Maxillofacial Surgery, King Saud Medical City, Riyadh, Saudi Arabia

    Bishi Abdullah Al-Garni

  4. Oral and Maxillofacial Surgery, Riyadh, Saudi Arabia

    Mohammed Abdullah Al-Qarzaee

Authors
  1. Ra’ed Ghaleb Salma
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fahad Mohammed Al-Shammari
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bishi Abdullah Al-Garni
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mohammed Abdullah Al-Qarzaee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ra’ed Ghaleb Salma.

Ethics declarations

The study was approved by the Ethical Committee of the Research Center of Riyadh Colleges of Dentistry and Pharmacy, in accordance with the ethical standards of the 1964 Helsinki Declaration and its later amendments.

Due to the retrospective nature of this study, informed consent is not required.

Sources of funds

Nil.

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Salma, R.G., Al-Shammari, F.M., Al-Garni, B.A. et al. Operative time, blood loss, hemoglobin drop, blood transfusion, and hospital stay in orthognathic surgery. Oral Maxillofac Surg 21, 259–266 (2017). https://doi.org/10.1007/s10006-017-0626-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10006-017-0626-1

Keywords

Search

Navigation