Administration of Steroids Is Associated With Increased Length of Stay But Not Post-Operative Complications or Readmissions in Patients Undergoing Orthognathic Surgery

Purpose: The purpose of this study is to examine the association of steroid use during orthognathic surgery and postoperative outcomes including major complications, 90-day all-cause readmission, and postoperative length of stay. Methods: A retrospective review was implemented utilizing the Pediatric Health Information System (PHIS) database from 2004 to 2014 was undertaken. Steroid exposure was defined as having been billed for the generic drug code for Dexamethasone (154035) at any time for up to 7 days from the surgery date. Unadjusted and adjusted random-intercept logistic regression models were utilized to assess the association between steroid exposure and these outcomes. Results: The sample included 5194 patients, 54% of patients were exposed to steroids, with 20.16 % exposed only on the day of surgery, 27.76% on the day of surgery and after, and 6.22% after the day of surgery. In models adjusting for age, sex, race, procedure, hospital variation and complex chronic conditions, the odds-ratio of steroid exposure was 3.46 (95% CI = 2.96-4.03) for an increased length of stay, 1.05 (95% CI = 0.81-1.37) for major complications and 1.20 (95% CI = 0.95-1.52) for 90-day all-cause readmission. Conclusion: The administration of steroids in patients undergoing orthognathic surgery is significantly associated with increased odds of length of stay. This may be due to a large set of patients receiving steroids during orthognathic procedure are less healthy than those not selected to receive steroids, and thereby require an increased length of stay. The limitations of large, administrative databases do not allow determination of this, but future prospective study is warranted.