Patient Characteristics and Anesthetic Factors Affecting Hospital Length of Stay in Orthognathic Surgery.

Abstract

Background: As orthognathic surgery increasingly shifts toward ambulatory pathways, identifying patients at risk for extended length of stay (eLOS) remains clinically important. This study evaluated preoperative patient characteristics and anesthetic factors associated with eLOS after orthognathic surgery.

Methods: A retrospective cohort study was performed of patients who underwent Le Fort I osteotomy at a single tertiary academic center between 2019 and 2025. Demographic, airway-related, anesthetic, and operative variables were extracted from the electronic medical record. The primary outcome was eLOS, defined as hospitalization of 2 or more days. Patients were compared by length-of-stay cohort, and multivariable logistic regression was used to identify independent predictors.

Results: The study included 170 patients, of whom 47 experienced eLOS. On unadjusted analysis, patients with eLOS had higher rates of obstructive sleep apnea (OSA), difficult airway history, elevated Mallampati class, ASA class III status, and longer anesthesia and operative durations. Higher ASA classification was associated with OSA, difficult airway history, elevated Mallampati scores, longer induction time, and increased use of indirect visualization during intubation. On multivariable regression, ASA class III independently predicted eLOS (adjusted odds ratio, 8.49; 95% CI: 2.09-40.0; P=0.004), as did longer operative duration (adjusted odds ratio, 1.50 per hour; 95% CI: 1.13-1.97; P=0.006).

Conclusions: ASA class III and longer operative duration independently predict eLOS after orthognathic surgery. ASA classification may serve as a practical preoperative surrogate for airway-related perioperative risk and help guide individualized postoperative monitoring.