LOS and Cost in Patients Undergoing Orthognathic Surgery: Does Surgeon Volume Matter?

Abstract Purpose The relationships between procedure-specific annual surgeon volume, hospital length of stay (LOS) and hospital costs for patients undergoing the two most common orthognathic surgical (OGS) procedures: segmental osteoplasty/osteotomy of the maxilla (SOM) or open osteoplasty/osteotomy of the mandibular ramus (SOMR) are not known. We hypothesized that treatment by high-volume surgeons will be associated with reduced LOS and costs. Patients and Methods All patients aged 9 to 65 years who underwent elective SOM or SOMR were selected from the 2001 to 2009 Nationwide Inpatient Sample. Patients with missing vital status, payment mode status or who underwent >1 OGS procedure during the index hospitalization were excluded. Based on year- and procedure-specific annual surgeon volumes, the highest (highest quartile) and the lowest (lowest quartile) procedure volume surgeon groups were compared. Multivariable logistic regression was used to study the relationship between surgeon volume and extended patient LOS (defined as LOS ≥ 75th percentile). Generalized linear models with a log-link and gamma distribution were used to examine association between surgeon volume and hospital costs. Models were adjusted for patient and hospital-level factors and type of procedure (either SOM or SOMR). Analysis was weighted to represent national-level estimates and alpha of 0.05 was used for all comparisons. Results After weighting to the population level, 8,062 patients were included for study. Most were white (80.6%), female (61.4%) and privately insured (84.6%). Mean age was 26 (±0.38) years. After adjusting for potential confounders, patients treated by high-volume surgeons demonstrated 40% lower odds of extended LOS (OR: 0.60; 95% CI: 0.38 to 0.95; P=0.032) and incurred substantially lower costs ($-1,484.74; 95% CI: -2782.76, -185.58; P=0.025) compared with patients treated by low volume surgeons. Conclusion These findings suggest the possibility that regionalization of patients to high-volume surgeons for OGS procedures may reduce LOS and incurred costs.