Provision of Mandibular Orthognathic Surgery in England

Objectives: To investigate mandibular orthognathic surgery activity in relation to patient factors, provider factors and temporal changes.

Methods: Data on hospital inpatient activity were extracted from the English national Hospital Episode Statistics (HES) database for the most recently available 9 years. Data processing and analysis were undertaken using the statistical software package STATA version 10. Thematic maps were generated using a geographical information systems software package.

Results: Mandibular procedures were carried out in 8,941 patients over 9 years and numbers rose annually. Almost two thirds of patients were female (63.0%) and there was a socio-economic gradient, with most patients living in affluent areas. Geographic variations in service provision were evident. A minority of provider units (18.3%) accounted for the majority of procedures (56.1%). The mean duration of inpatient stay was 3.2 days and this decreased over the period. Inpatient stays were significantly shorter in high volume provider units compared with low volume provider units (P<0.001). There has been an increasing trend for inpatient stays of one day duration or less (annual OR 1.19, 95%CI 1.15 to 1.23, P<0.001). Almost two fifth of patients (39.3%) underwent an additional surgical procedure at the same time as their mandibular surgery, with the most common procedure being a maxillary osteotomy (88.1% of the 39.3%). Six percent of cases involved a stay in an intensive care or high dependency unit. The majority of patients were discharged from hospital with clinical consent (97.9%).There were 138 patients who required re-operation and one post-operative death.

Conclusion: Mandibular orthognathic surgery is being increasingly provided in England, and with increasing efficiency. However there are substantial inequalities in the regional availability of services and patient access.