Scientific and Technological Research
Predictors of pain and prolonged length of stay after orthognathic surgery: A retrospective cohort study
Predictores de dolor y tiempo de internación prolongado tras cirugía ortognática: estudio de cohorte retrospectivo
Adriana Shinagawaa, Fernando Elias Melhema, Antônio Carlos de Camposa, Domingos Dias Cicarellib,
, Elke Frerichsb
Corresponding author
dcicarelli@uol.com.br
Corresponding author at: Department of Anesthesiology, University Hospital of São Paulo University, Av. Prof. Lineu Prestes, 2.565 Cidade Universitária, São Paulo, SP CEP 05508-000, Brazil.
Corresponding author at: Department of Anesthesiology, University Hospital of São Paulo University, Av. Prof. Lineu Prestes, 2.565 Cidade Universitária, São Paulo, SP CEP 05508-000, Brazil.
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Prof. Lineu Prestes, 2.565 Cidade Universitária, São Paulo, SP CEP 05508-000, Brazil." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Predictores de dolor y tiempo de internación prolongado tras cirugía ortognática: estudio de cohorte retrospectivo" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1602 "Ancho" => 2209 "Tamanyo" => 88413 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Scatter plot of LOS and duration of anesthesia.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Orthognathic treatment has assumed an important role in orthodontics and maxillofacial surgery over the past 3–4 decades, with esthetic, functional and social impact on the quality of life of patients.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However, little has been investigated whether clinical practice features have affected variables such as postoperative pain, duration of inpatient stay or chance of requiring high level nursing (sub acute care). These issues are clearly important when orthognathic treatment is done in a publicly funded health care system as they influence the use of resources. Improved knowledge in this field would increase the ability of public health systems to plan their provision of these services and allocate resources appropriately.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Reduction of postoperative pain (PP) and of length of stay (LOS) after surgery can result in improved allocation and use of health care resources and a substantial reduction in the cost of health care delivery. Although a number of reports have attempted to identify patient characteristics and perioperative adverse events that correlate with pain and prolonged hospital stay, there is a paucity of published papers focused on PP or LOS after orthognathic surgery.</p><p id="par0015" class="elsevierStylePara elsevierViewall">A better understanding of the variables affecting PP and LOS may allow surgeons to assess the management of patients undergoing orthognathic surgery, and hence improve patient care and discharge planning.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The overall purpose of this study was to estimate the postoperative pain (PP) and the hospital length of stay (LOS) after orthognathic surgery in a large series of patients. The specific aims of this study were to identify major factors associated with PP and LOS, and to determine predictors of PP and prolonged LOS after orthognathic surgery.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">Investigators evaluated clinical records from subjects who underwent orthognathic surgery from 2008 to 2010, in a retrospective cohort study. A total of 67 patients were admitted for surgical treatment in the Department of Oral and Maxillofacial Surgery. Fifty-two patients (32 females, 20 males) who underwent orthognathic surgery were selected. Patient age ranged from 16 to 63 years (average age 29).</p><p id="par0030" class="elsevierStylePara elsevierViewall">Subjects included in the sample had congenital or acquired skeletal deformities corrected using conventional orthognathic operations. Subjects undergoing distraction osteogenesis were excluded. This study was reviewed and approved by the Ethics Committee of the University Hospital.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Study variables</span><p id="par0035" class="elsevierStylePara elsevierViewall">Study variables were grouped into the following sets: patient characteristics, preoperative, intraoperative and postoperative. Patient variables were age, sex, and body mass index (BMI). Preoperative variables include ASA classification, medical history, acquired habits and physiological data.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The intraoperative variables were divided into subgroups surgical and anesthesia. Surgical subgroup variables include location, procedure type, use of segmental maxillary osteotomies, whether bone grafting or ancillary procedures were performed, and duration of operation. Location was categorized as mandibular, maxillary, or bimaxillary cases. Procedure types included Le Fort I, bilateral sagittal split osteotomy (BSSO) or vertical ramus osteotomy (VRO) and surgically assisted palatal expansion. In the setting of Le Fort osteotomies, the number of segments was recorded as 1, 2, or 3 pieces. Anesthesia subgroup variables were anesthesia method, anesthetic agents and supplementary medication. The anesthesia method was categorized as normotensive or hypotensive anesthesia (reduction of systolic pressure to 80–90<span class="elsevierStyleHsp" style=""></span>mmHg, or mean arterial pressure of 50–60<span class="elsevierStyleHsp" style=""></span>mmHg or reduction of 30% of mean arterial pressure of baseline).<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Anesthetic agents such as local anesthetics, inhaled general anesthetic agents, intravenous non-opioid anesthetic agents, intravenous opioid analgesic agents, and reversal agents were noted, as well as supplementary medication (perioperative steroid use, anti-inflammatory or analgesic prescription).</p><p id="par0045" class="elsevierStylePara elsevierViewall">Postoperative adverse events were collected and included pain, postoperative nausea and vomiting (PONV), bleeding, superficial and deep wound infection, wound dehiscence and other. Patients were routinely medicated with intravenous nonsteroidal anti-inflammatory drugs (Ketoprofen 100<span class="elsevierStyleHsp" style=""></span>mg or Ketorolac 30<span class="elsevierStyleHsp" style=""></span>mg every 12<span class="elsevierStyleHsp" style=""></span>h), corticosteroid (hydrocortisone 100<span class="elsevierStyleHsp" style=""></span>mg or dexamethasone 4<span class="elsevierStyleHsp" style=""></span>mg every 12<span class="elsevierStyleHsp" style=""></span>h) and dipyrone (2<span class="elsevierStyleHsp" style=""></span>g every 6<span class="elsevierStyleHsp" style=""></span>h). In postoperative period, patients were evaluated with visual analog scale (VAS) pain scores during 24<span class="elsevierStyleHsp" style=""></span>h. If patients recorded VAS>5, tramadol (100<span class="elsevierStyleHsp" style=""></span>mg every 6<span class="elsevierStyleHsp" style=""></span>h) was used as rescue medication.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Predictors</span><p id="par0050" class="elsevierStylePara elsevierViewall">The outcome variables were PP and LOS. PP was categorized as yes/no response and duration of PP in days. LOS was computed as the time interval (in days) between discharge from the operating room recorded on the nurse's operating room note and the time at which discharge orders were signed. Variables associated with PP and duration of LOS were considered as primary predictor variables.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The hospital discharge criteria used were normal ambulation and mental status, absence of nausea and vomiting, minimal pain controlled with oral analgesics, no surgical bleeding, capacity of fluid intake, presence of diuresis and presence of an adult escort.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Data analyses</span><p id="par0060" class="elsevierStylePara elsevierViewall">Descriptive statistics was computed for each variable. Pearson Chi-Square test and Fisher's exact test were used to identify variables associated with PP and duration of LOS. Associations among variables, PP and LOS were tested with the Pearson correlation test. The level of statistical significance was set at <span class="elsevierStyleItalic">p</span> ≤0.05. Statistical analysis was performed using Minitab Statistical Software for Windows version 15.0 (Minitab Inc, USA).</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">Fifty-two patients (32 females, 20 males) who underwent orthognathic surgery were studied. The demographic data of the sample are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Most patients (51.7%) were healthy or without any preoperative medical compromises; 10.3% had a cardiovascular disease, 13.8% had a respiratory disorder and 17.2% had some other disorders.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">The surgical procedure types and duration of surgery are summarized in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. Mean length of operation was 330.0<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>163.2<span class="elsevierStyleHsp" style=""></span>min. The distribution of the different operations is shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Bimaxillary osteotomies were performed in 31% of patients. Le Fort and/or BSSO were the most frequent type of procedure, followed by surgically assisted palatal expansion. Ancillary procedures included third molar extraction, septoplasty, genioplasty and coronoidectomy. Bone grafting materials used were polyethylene implants, hydroxyapatite and autogenous bone. Postoperative nausea and vomiting was the most frequent adverse event; bleeding was also observed.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">The type of anesthesia, postoperative complications and length of stay are summarized in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>.</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Postoperative pain – predictive factors</span><p id="par0080" class="elsevierStylePara elsevierViewall">About 27.6% of patients undergoing orthognathic surgery had pain in the postoperative period and 62.5% of complainants were male but there was no statistically significant difference (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.12).</p><p id="par0085" class="elsevierStylePara elsevierViewall">Intravenous lidocaine boluses of 1.5<span class="elsevierStyleHsp" style=""></span>mg/kg used during general anesthesia (in 32 patients during induction and immediately before extubation) were associated with PP: 87.5% of the patients who received lidocaine had complained of pain (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.03).</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Length of stay – predictive factors</span><p id="par0090" class="elsevierStylePara elsevierViewall">The average length of stay was 2.1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.4 days (range, 1–8 days; median, 1 day). Sixty-two percent (62%) of the patients were discharged the next day of surgery. Approximately twenty-eight percent (28%) were admitted for more than two days; one patient was admitted for longer than five-day period.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Data analysis detected gender, location of procedure, type and duration of anesthesia as probable predisposing factors. Seventy-five percent of patients admitted for longer than two days were male (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.008). Bimaxillary procedures demanded shorter hospitalization; single-jaw surgery required longer hospitalization (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.008).</p><p id="par0100" class="elsevierStylePara elsevierViewall">Patients undergoing inhalational anesthesia (sevoflurane/isoflurane) stayed longer in hospital (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.01) compared with those who underwent total intravenous anesthesia.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Prolonged anesthesia time significantly correlated with admission time. There was a positive and significant correlation (Pearson <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.558; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.002) between length of stay and duration of general anesthesia (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discussion</span><p id="par0110" class="elsevierStylePara elsevierViewall">As orthognathic surgical procedures have evolved, several aspects of the management of these patients have changed. Many surgical and anesthesia advances allow faster treatment and care, and more selected orthognathic procedures have been performed with improved patient's outcome. Perhaps the most significant advance has been the use of rigid fixation. Rigid fixation facilitates oral hygiene, comfort, and nutrition, but more importantly, airway management that eases concerns over the difficulty patients may have postoperatively with nausea. The development of microsurgical instrumentation, including saws, drills, and retractors, has improved the surgeon's ability to make the precise bony cuts necessary to successfully perform osteotomies. This, in addition to familiarity with the surgical procedures, has allowed surgeons to decrease operating time. Also, the role of systemic steroids in decreasing surgical edema is well documented. This benefit is extremely important in orthognathic surgery because of the proximity of the airway to the surgical site.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a> Finally, anesthetic management with innovative techniques and better agents contribute to the overall success. Inhalation agents, opioids, and muscle relaxants have been developed with a short half-life to quickly exit the body after surgery, decreasing recovery time. In the majority of orthognathic surgical procedures a number of agents are used to achieve controlled, modified hypotension. Inducing hypotension has the effect of decreasing blood loss and lessening the fluid replacement needs.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8–12</span></a> Both increase the likelihood of early discharge.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,6,7</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">The gender distribution of this patient population was typical for orthognathic surgery patients and those suffering from TMJ problems in general. Women more often had pain problems and cosmetic concerns, and they generally seemed to seek help for these problems more actively than did men. The reasons for seeking treatment were functional and pain related in most patients.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Only patients ASA I and II were included, probably because this type of surgery was more frequently performed in younger patients.</p><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Postoperative pain and complications</span><p id="par0125" class="elsevierStylePara elsevierViewall">Most patients with postoperative pain were ready to go home after two days. Adequate pain control was not achieved in two patients until the third hospital day. As seen by other authors, patient's age, sex and ethnic origin did not affect the severity of postoperative pain.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,14,15</span></a> Niederhagen et al.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> found, however, that postoperative pain intensity was significantly correlated to operating time, the frequency of analgesic demand and the type of surgery (orthognathic surgery<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>other maxillofacial surgeries).</p><p id="par0130" class="elsevierStylePara elsevierViewall">Some anesthesiologists in our hospital use boluses of intravenous lidocaine to reduce cough reflex of patients during intubation and extubation. This is an individual practice, not standardized in our service. Intravenous lidocaine boluses used in general anesthesia were found to have no beneficial effect on postoperative pain.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16,17</span></a> Although the analgesic effects of systemic lidocaine have been proven for chronic pain, conflicting results have been achieved in acute pain, such as postoperative pain.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16–20</span></a> It seems that perioperative lidocaine the development of pronounced central hyperalgesia as abdominal surgeries.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18–23</span></a> For instance, intravenous lidocaine infusion did not result in any significant reduction in visual analogic scale pain scores or postoperative analgesic requirements in patients undergoing tonsillectomy or in patients undergoing surgical procedures with bone and cartilage trauma as in orthopedic or cardiac surgeries.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18,22</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Some patients had nausea and vomiting after the first postoperative day but required no prolonged hospital admission. Postoperative nausea with or without vomiting can be minimized by reducing anesthesia time and use of inhalation anesthetics.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">There were no intraoperative transfusions, but there were cases of bleeding and epistaxis. Although bleeding complications are not unique to orthognathic surgery, the consequences can be severe. Surgical planning and a thorough medical history are paramount in avoiding such complications.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Length of stay</span><p id="par0145" class="elsevierStylePara elsevierViewall">The mean LOS for all procedures was 2 days. This value falls within the lower end of the range of 1.2–8.5 days reported in the literature for patients undergoing orthognathic surgery.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3,6,13,24–27</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">From 1975—when Tornes and Lyberg<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> found that average hospital stay was 8.5 days for surgical correction of mandibular prognathism—to present time, literature shows that there was a significant reduction over time, which was almost certainly the result of improved surgical and anesthetic techniques, as well as the increase in the use of rigid intermaxillary fixation (IMF) and perioperative steroids.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> In Brazil, public data from 2008 to 2011 showed that the mean inpatient stay was 3 days.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">Based on the results, male gender, procedure type, use of inhalational anesthesia and increased duration of anesthesia were associated with increased LOS.</p><p id="par0160" class="elsevierStylePara elsevierViewall">Huamán et al. also found an association between gender and LOS; however, in their sample, female gender was associated with an increased LOS.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">Procedure type was commonly associated with LOS, as seen in Lombardo et al.,<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> Lupori et al.,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and Huamán et al.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>; they all reported the longest LOS in bimaxillary procedures, followed by single jaw procedures. Our findings, however, were similar to Panula et al.,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> who, unexpectedly, found longer LOS in patients with single-jaw maxillary discrepancies compared with those with bimaxillary discrepancies. We conjecture that the longest hospitalization in single-jaw surgery is linked to the type of anesthesia selected for these procedures (inhalational anesthesia).</p><p id="par0170" class="elsevierStylePara elsevierViewall">Patients undergoing inhalational anesthesia stayed longer in hospital (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.01) compared with those who underwent total intravenous anesthesia. Typically, the total intravenous anesthesia technique has faster recovery than the inhalational anesthesia technique.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> A systematic review on postoperative recovery and complications using different anesthetic techniques showed no significant difference in the early recovery between the intravenous anesthesia (propofol) and inhalational anesthesia (sevoflurane), but with significant heterogeneity. The time to home discharge, however, was earlier with propofol compared with sevoflurane; also, the postoperative complications, including PONV, were significantly greater with sevoflurane.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> Above results may explain the greater length of stay that was seen in the inhalational technique.</p><p id="par0175" class="elsevierStylePara elsevierViewall">There was a significant correlation between anesthesia time and discharge home or admission for observation.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> The average duration of anesthesia was 330<span class="elsevierStyleHsp" style=""></span>min; when the anesthesia time was greater than 5<span class="elsevierStyleHsp" style=""></span>h, mean LOS was 3 days. Lupori et al.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and Huamán et al.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> have also determined that increased duration of anesthesia resulted in increased frequency of hospital admissions.</p><p id="par0180" class="elsevierStylePara elsevierViewall">Retrospective studies are important to improve management variables which can affect the success of orthognathic surgery. Enhancement of maxillofacial surgery procedures as the sagittal split osteotomy as hospital costs are decreased.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,27</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">The major limitation of this study rests in its retrospective nature and the small number of patients analyzed. In our study, there were no hospital readmissions despite the longer duration of anesthesia procedure. The inclusion of patients classified as ASA I and II can probably explain this result, as well as the low mean age of our patients. The results of other studies suggest that patients older than 40 years have longer hospital stays and an increased risk of complications and readmissions.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a></p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Ethical disclosures</span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Protection of human and animal subjects</span><p id="par0190" class="elsevierStylePara elsevierViewall">The authors declare that the procedures followed were in accordance with the regulations of the relevant clinical research ethics committee and with those of the Code of Ethics of the World Medical Association (Declaration of Helsinki).</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Confidentiality of data</span><p id="par0195" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Right to privacy and informed consent</span><p id="par0200" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.</p></span></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Funding</span><p id="par0205" class="elsevierStylePara elsevierViewall">The authors have not received any funding for producing this article.</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Conflicts of interest</span><p id="par0210" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres474601" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objectives" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Materials and methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec496795" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres474600" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Materiales y métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec496794" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study variables" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Predictors" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Data analyses" ] ] ] 6 => array:3 [ "identificador" => "sec0030" "titulo" => "Results" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Postoperative pain – predictive factors" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Length of stay – predictive factors" ] ] ] 7 => array:3 [ "identificador" => "sec0045" "titulo" => "Discussion" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "Postoperative pain and complications" ] 1 => array:2 [ "identificador" => "sec0055" "titulo" => "Length of stay" ] ] ] 8 => array:3 [ "identificador" => "sec0060" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0065" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0070" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0075" "titulo" => "Right to privacy and informed consent" ] ] ] 9 => array:2 [ "identificador" => "sec0080" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0085" "titulo" => "Conflicts of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-04-24" "fechaAceptado" => "2015-01-19" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec496795" "palabras" => array:5 [ 0 => "Orthognathic surgery" 1 => "Pain, postoperative" 2 => "Anesthesia" 3 => "Length of stay" 4 => "Pain" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec496794" "palabras" => array:5 [ 0 => "Cirugía ortognática" 1 => "Dolor posoperatorio" 2 => "Anestesia" 3 => "Tiempo de internación" 4 => "Pain" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Orthognathic treatment has assumed an important role in orthodontics and maxillofacial surgery in the last years; however, little has been investigated about this type of treatment.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objectives</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The main purpose of this study was to identify major factors and/or predictors associated with postoperative pain (PP) and hospital length of stay (LOS) after orthognathic surgery.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Materials and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">52 patients who underwent orthognathic surgery from 2008 to 2010 at the University Hospital of São Paulo University were investigated. Study variables such as patient characteristics, preoperative, intraoperative and postoperative data were collected. The outcome variables were PP and LOS. Descriptive and analytical statistics was computed for all variables.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">27.6% of patients had pain in the postoperative period. Lidocaine used in general anesthesia was an associated factor of PP. The overall mean LOS was 2 days; gender, location of procedure, type and duration of anesthesia were identified as probable predisposing factors. There was a significant correlation between anesthesia time and discharge. Anesthesia variables were more predictably related with postoperative pain and hospitalization time. Location of orthognathic procedure, however, was an important surgical variable that influenced in LOS.</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Intravenous lidocaine boluses used during general anesthesia were associated with PP. Male patients, single-jaw surgery, inhalational anesthesia and duration of anesthesia were predisposing factors that improve LOS.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objectives" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Materials and methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducción</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">la cirurgía ortognática ha asumido un papel importante en la ortodoncia y en la cirugía maxilofacial en los últimos años. Sin embargo, se ha investigado poco sobre este tipo de tratamiento.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">el objetivo principal de este estudio fue identificar los principales factores o predictores asociados con el dolor posoperatorio (DP) y el tiempo de internación (TI) después de la cirugía ortognática.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Materiales y métodos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">fueron estudiados 52 pacientes que se sometieron a cirugía ortognática (2008 - 2010) en el Hospital Universitario de la Universidad de São Paulo. Se recolectaron variables de estudio tales como características de los pacientes y datos perioperatorios. Estadística descriptiva y analítica se calculó para todas las variables.</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">el 27,6% de los pacientes presentaron dolor en el posoperatorio. La lidocaína utilizada en la anestesia general fue un factor asociado del DP. El TI medio global fue de 2 días. El género, la localización del procedimiento, el tipo y la duración de la anestesia se identificaron como factores predisponentes probables. Hubo una correlación significativa entre el tiempo de anestesia y de descarga. Las variables de anestesia podían predecirse más cuando estaban relacionadas con el DP y el TI. La localización de la cirurgía ortognática, sin embargo, fue una variable quirúrgico importante que influyó en lo TI.</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">la lidocaína intravenosa en bolo utilizada durante la anestesia general se asoció con el DP. Los pacientes varones, la cirugía sobre una sola mandíbula, la anestesia inhalatoria y la duración de la anestesia fueron factores predisponentes que prolongaron el TI.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Materiales y métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Shinagawa A, Melhem FE, de Campos AC, Cicarelli DD, Frerichs E. Predictores de dolor y tiempo de internación prolongado tras cirugía ortognática: estudio de cohorte retrospectivo. Rev Colomb Anestesiol. 2015;43:129–135.</p>" ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1602 "Ancho" => 2209 "Tamanyo" => 88413 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Scatter plot of LOS and duration of anesthesia.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "tabla" => array:2 [ "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">SD – standard deviation, M/F – male/female, BMI – body mass index, ASA – American Society of Anesthesiologists.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Patient variables</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Age (years – mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">29.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>10.0 (16–63) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Gender (M/F) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">37%/63% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Body mass index (BMI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">23<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5 (18–38) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>BMI<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17.2% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Preoperative</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>ASA classification (I/II) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">62%/38% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Medical history \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Alcohol consumption, yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6.9% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Smoking, yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10.3% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab745817.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Demographic data.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "tabla" => array:2 [ "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">BSSO – Sagittal Split Osteotomy, VRO – Vertical Ramus Osteotomy.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleBold">Operative</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Length of operation, min</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">330.0<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>163.2 (60–660) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Location</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Bimaxillary \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31.0% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Mandibular \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.7% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Maxillary \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48.3% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleBold">Procedure type</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Le Fort</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.7% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Le Fort</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">+</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">BSSO</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31.0% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">BSSO or VRO, only</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.2% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Surgically assisted palatal expansion</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.7% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Other</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.3% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Ancillary procedures, yes</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44.8% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Bone grafting, yes</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.7% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab745818.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Surgical procedure types and duration of surgery.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "tabla" => array:2 [ "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">PONV – Postoperative Nausea and Vomiting.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Anesthesia</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Normotensive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51.7% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hypotensive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48.3% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Postoperative</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>PONV, yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13.8% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Bleeding, yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.4% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Wound infection, yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Wound dehiscence, yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Outcome</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Length of stay, days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.4 (1–8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Postoperative pain, yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.6% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab745819.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Type of anesthesia and postoperative complications.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:32 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Life-quality of orthognathic surgery patients: the search for an integral diagnosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.A. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 1 | 0 | 1 |
| 2024 October | 18 | 0 | 18 |
| 2024 September | 23 | 2 | 25 |
| 2024 August | 30 | 3 | 33 |
| 2024 July | 19 | 3 | 22 |
| 2024 June | 21 | 5 | 26 |
| 2024 May | 24 | 2 | 26 |
| 2024 April | 28 | 7 | 35 |
| 2024 March | 28 | 5 | 33 |
| 2024 February | 33 | 7 | 40 |
| 2024 January | 28 | 9 | 37 |
| 2023 December | 28 | 17 | 45 |
| 2023 November | 23 | 13 | 36 |
| 2023 October | 36 | 15 | 51 |
| 2023 September | 10 | 3 | 13 |
| 2023 August | 28 | 6 | 34 |
| 2023 July | 9 | 3 | 12 |
| 2023 June | 26 | 3 | 29 |
| 2023 May | 39 | 6 | 45 |
| 2023 April | 28 | 3 | 31 |
| 2023 March | 20 | 3 | 23 |
| 2023 February | 10 | 2 | 12 |
| 2023 January | 14 | 6 | 20 |
| 2022 December | 20 | 5 | 25 |
| 2022 November | 21 | 4 | 25 |
| 2022 October | 42 | 11 | 53 |
| 2022 September | 54 | 8 | 62 |
| 2022 August | 15 | 12 | 27 |
| 2022 July | 16 | 7 | 23 |
| 2022 June | 15 | 10 | 25 |
| 2022 May | 10 | 8 | 18 |
| 2022 April | 15 | 9 | 24 |
| 2022 March | 39 | 6 | 45 |
| 2022 February | 36 | 4 | 40 |
| 2022 January | 57 | 5 | 62 |
| 2021 December | 56 | 10 | 66 |
| 2021 November | 42 | 9 | 51 |
| 2021 October | 47 | 11 | 58 |
| 2021 September | 33 | 12 | 45 |
| 2021 August | 28 | 4 | 32 |
| 2021 July | 24 | 9 | 33 |
| 2021 June | 26 | 7 | 33 |
| 2021 May | 37 | 6 | 43 |
| 2021 April | 72 | 7 | 79 |
| 2021 March | 47 | 6 | 53 |
| 2021 February | 18 | 8 | 26 |
| 2021 January | 9 | 11 | 20 |
| 2020 December | 21 | 7 | 28 |
| 2020 November | 32 | 11 | 43 |
| 2020 October | 18 | 4 | 22 |
| 2020 September | 17 | 6 | 23 |
| 2020 August | 17 | 4 | 21 |
| 2020 July | 18 | 0 | 18 |
| 2020 June | 10 | 1 | 11 |
| 2020 May | 15 | 9 | 24 |
| 2020 April | 13 | 1 | 14 |
| 2020 March | 14 | 2 | 16 |
| 2020 February | 14 | 3 | 17 |
| 2020 January | 17 | 4 | 21 |
| 2019 December | 8 | 2 | 10 |
| 2019 November | 5 | 3 | 8 |
| 2019 October | 4 | 0 | 4 |
| 2019 September | 5 | 3 | 8 |
| 2019 August | 1 | 0 | 1 |
| 2019 July | 4 | 6 | 10 |
| 2019 June | 2 | 0 | 2 |
| 2019 May | 5 | 11 | 16 |
| 2019 March | 1 | 0 | 1 |
| 2018 September | 1 | 0 | 1 |
| 2018 June | 3 | 2 | 5 |
| 2018 May | 23 | 3 | 26 |
| 2018 April | 27 | 8 | 35 |
| 2018 March | 15 | 8 | 23 |
| 2018 February | 17 | 4 | 21 |
| 2018 January | 32 | 3 | 35 |
| 2017 December | 26 | 7 | 33 |
| 2017 November | 20 | 7 | 27 |
| 2017 October | 20 | 9 | 29 |
| 2017 September | 36 | 6 | 42 |
| 2017 August | 40 | 6 | 46 |
| 2017 July | 37 | 7 | 44 |
| 2017 June | 61 | 12 | 73 |
| 2017 May | 53 | 5 | 58 |
| 2017 April | 53 | 11 | 64 |
| 2017 March | 35 | 4 | 39 |
| 2017 February | 28 | 1 | 29 |
| 2017 January | 20 | 7 | 27 |
| 2016 December | 33 | 9 | 42 |
| 2016 November | 42 | 5 | 47 |
| 2016 October | 37 | 5 | 42 |
| 2016 September | 41 | 6 | 47 |
| 2016 August | 40 | 8 | 48 |
| 2016 July | 23 | 8 | 31 |
| 2016 May | 3 | 0 | 3 |
| 2016 April | 1 | 0 | 1 |
| 2016 March | 1 | 0 | 1 |
| 2016 February | 9 | 0 | 9 |
| 2015 December | 11 | 0 | 11 |
| 2015 November | 41 | 14 | 55 |
| 2015 October | 63 | 21 | 84 |
| 2015 September | 35 | 13 | 48 |
| 2015 August | 51 | 12 | 63 |
| 2015 July | 49 | 13 | 62 |
| 2015 June | 37 | 5 | 42 |
| 2015 May | 83 | 13 | 96 |
| 2015 April | 41 | 11 | 52 |
Show all