Impact of Perioperative Fluid Administration on Postoperative Morbidity and Length of Hospital Stay Following Maxillomandibular Advancement for Obstructive Sleep Apnea.

Abstract

PURPOSE:

The purpose of this study was to evaluate whether the volume of perioperative fluids administered to patients undergoing maxillomandibular advancement (MMA) for treatment of obstructive sleep apnea (OSA) is associated with an increased incidence of postoperative complications and prolonged length of hospital stay.

MATERIALS AND METHODS:

A retrospective cohort study design was implemented and patients undergoing MMA for OSA at the Mayo Clinic were identified from 2001 through 2014. The primary predictor variable was the total volume of intravenous fluids administered during MMA. The primary outcome variable was length of hospital stay in hours. Secondary outcome variables included the presence of complications incurred during postoperative hospitalization. Additional covariates abstracted included basic demographic data, preoperative body mass index, preoperative apnea-hypopnea index, preoperative Charlson comorbidity index, preoperative American Society of Anesthesiologists score, type of intravenous fluid administered, surgical complexity score, duration of anesthesia, duration of surgery, and the use of planned intensive care unit admission. Univariate and multivariable models were developed to assess associations between the primary predictor variable and covariates relative to the primary and secondary outcome variables.

RESULTS:

Eighty-eight patients undergoing MMA for OSA were identified. Total fluid volume was significantly associated with increased length of stay (odds ratio [OR] = 1.34, 95% confidence interval [CI], 1.05-1.71; P = .020) in univariate analysis. Total fluid volume did not remain significantly associated with increased length of hospital stay in stepwise multivariable modeling. Total fluid volume was significantly associated with the presence of postoperative complications (OR = 1.69; 95% CI, 1.08-2.63; P = .021) in univariate logistic regression.

CONCLUSION:

Fluid administration was not found to be significantly associated with increased length of hospital stay after MMA for OSA. Increased fluid administration might be associated with the presence of postoperative complications after MMA; however, future large multicenter studies will be required to more comprehensively assess this association.

• Authors: Kyle S Ettinger, Cody C Wyles, Brett J Bezak, Yavuz Yildirim, Kevin Arce, Christopher F Viozzi
• Journal: Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons (J Oral Maxillofac Surg) Vol. 73 Issue 7 Pg. 1372-83 (Jul 2015) ISSN: 1531-5053 [Electronic] United States
• PMID: 25843820 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Chemical References

• Crystalloid Solutions
• Isotonic Solutions

Topics

• Adolescent
• Adult
• Aged
• Anesthesia, Dental (statistics & numerical data)
• Anesthesia, General (statistics & numerical data)
• Body Mass Index
• Cohort Studies
• Critical Care (statistics & numerical data)
• Crystalloid Solutions
• Female
• Fluid Therapy (statistics & numerical data)
• Follow-Up Studies
• Genioplasty (methods)
• Hospitalization (statistics & numerical data)
• Humans
• Isotonic Solutions (therapeutic use)
• Length of Stay (statistics & numerical data)
• Male
• Mandibular Advancement (methods)
• Maxillary Osteotomy (methods)
• Middle Aged
• Operative Time
• Osteotomy, Le Fort (methods)
• Osteotomy, Sagittal Split Ramus (methods)
• Postoperative Complications
• Retrospective Studies
• Sleep Apnea, Obstructive (classification, surgery)
• Young Adult