The Impact of Using Enhanced Recovery After Surgery Approach on Orthognathic Surgery Outcome: A Historical Cohort Study
Binnur Çavdaroğlu, Emine Aysu Şalvız, Momunat Dadashova, Gökçe Aliş, Tareq A.I. Damery, Erol Kozanoğlu, Muhammet Çayır, Bora Edim Akalın, Ufuk Emekli, Kamil Mehmet Tuğrul
Aim: Orthognathic surgeries are generally associated with blood loss, swelling, postoperative nausea vomiting (PONV) and pain (1-4). The aim of this study is to improve postoperative outcome in patients undergoing orthognatic surgeries by the use of Enhanced Recovery After Surgery (ERAS) protocols.
Material methods: After Ethics Committee approval (2020/965), the data of 90 patients who underwent elective orthognathic surgery, were investigated. Following standard monitorization and general anesthesia; Group 1 patients were applied traditional approach and received intraoperative 10 mL/kg/h IV izolen infusion. Group 2 received ERAS approach. Patients in Group 2 did not preoperatively smoke for 48 hours, drank clear liquids until the last 2 hours, and received 6 mL/kg/h IV izolen intraoperatively. In these; gastric aspiration was also applied before extubation, PONV prophylaxis and patient controlled analgesia was added to the routine plans for the first postoperative 48 hours. The primary endpoint was length of hospital stay. The secondary endpoints were intraoperative follow-up data, length of postanesthesia care unit (PACU) stay, numeric rating scale (NRS) pain scores, opioid consumption and PONV incidences through the postoperative first 48 hours, and satisfaction scores.
Results: Eighty-six patients’ data were complete (Figure 1). Demographics were comparable (p>0.05). Intraoperative amount of infused izolen, blood loss and pre-/postoperative Hb differences were lower in Group 2 (p≤0.05) (Table 1). During the postoperative first 48 hours; although NRS scores were lower (especially on 0th min, 1st, 2nd, 24th and 48th hours) in Group 2 (p≤0.05), total opioid consumption was similar to Group 1 (Table 2). In Group 2, fewer patients described PONV on different time points (Table 3). Lengths of PACU and hospital stays were both shorter, and patients were more satisfied in Group 2 (p≤0.05) (Table 1).
Conclusion: We believe that the comfort and satisfaction of patients undergoing orthognathic surgeries can be improved by ERAS protocols.
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