Reduction in same-day readmission rate for orthognathic surgery with a new Enhanced Recovery After Surgery protocol

Abstract Objectives We aimed to evaluate how a newly implemented Enhanced Recovery After Surgery (ERAS) protocol affected same-day discharge after orthognathic surgery. Materials and Methods A retrospective, cohort study was performed on participants having undergone orthognathic surgery between 2015 and 2022 in our tertiary French department either via the former traditional non-ERAS or new ERAS protocol. The primary study endpoint was difference in unplanned same-day readmission (SDR) rates between protocol types. Multivariate logistic regression was used to identify predictors of SDR. Results A total of 511 participants were included: n = 212(41.5%) followed the non-ERAS protocol and n = 299(58.5%) the ERAS protocol. SDR was significantly higher in the non-ERAS group (38.2%) compared to the ERAS group (24.1%) (p < 0.001), corresponding to a 37% relative reduction in SDR. In multivariate analysis, later surgery end time (adjOR 1.2, 95%CI 1.1–1.3; p < 0.001), associated genioplasty (adjOR 2.1, 95%CI 1.3–3.3; p = 0.0013), maxillary osteotomy (adjOR 2.6, 95%CI 1.5–4.4; p = 0.0004), and combined osteotomy (adjOR 4.1, 95%CI 2.5–6.8; p < 0.0001) were independently associated with higher SDR. Conversely, ERAS protocol implementation remained protective (adjOR 0.5, 95%CI 0.3–0.8; p = 0.004). Interaction analysis demonstrated that ERAS protocol implementation significantly reduced the risk of SDR among patients undergoing combined osteotomy (adjOR 0.39, 95%CI 0.16–0.95; p = 0.039). Conclusions ERAS protocol implementation reduced the risk of SDR with the greatest benefit observed for complex combined osteotomies. Clinical Relevance These findings support our ERAS protocol as a safe and effective for promoting outpatient orthognathic surgery, particularly in reducing complications after complex procedures.