Factors influencing intraoperative and postoperative complication occurrence

OBJECTIVES: In periodontology, it is widely recognized that evidence characterizing the incidence and effect of treatment complications is lacking. The objective of this study was to assess the influence of operator-, procedure-, patient-, and site-associated factors on intraoperative and postoperative complication occurrence. METHODS: A single investigator reviewed records of patients treated by eight periodontics residents from July 2018 through June 2022. For each procedure, the investigator recorded and graded each intraoperative and postoperative complication or indicated that no complication had occurred. These outcomes were analyzed against a panel of explanatory covariates. RESULTS: A total of 1135 procedures were included in the analysis. Intraoperative and postoperative complications were identified in 2.8% and 15.2% of procedures, respectively. The most common intraoperative complications were Schneiderian membrane perforation (1.3%) and gingival flap perforation/tear (1%), and the most common postoperative complications were dentin hypersensitivity (2.6%), excessive pain (2.5%), and infection (2.2%). Subepithelial connective tissue graft (OR: 3.2, 95% CI: 1.6, 6.1; p<.001), guided bone regeneration (OR: 3.0, 95% CI: 1.4, 6.5; p=.004), and guided bone regeneration with implant placement (OR: 3.1, 95% CI: 1.3, 7.6; p=.011) were associated with higher odds of postoperative complication, whereas lateral sinus elevation (OR: 102.5, 95% CI: 12.3, 852.9; p<.001), transalveolar sinus elevation (OR: 22.4, 95% CI: 2.2, 224.5; p=.008), open flap debridement (OR: 36.4, 95% CI: 3.0, 440.7; p=.005), and surgically facilitated orthodontic therapy (OR: 20.5, 95% CI: 1.2, 358.4; p=.039) were associated with higher odds of intraoperative complication occurrence. CONCLUSIONS: Consistent with previous reports, procedure type appears to be the predominant factor driving complication occurrence. As analyses of treatment complications increase, individualized risk-benefit assessments will become progressively meaningful for patients. IMPLICATIONS: An accurate appraisal of the risks associated with a procedure are necessary for patient consent concerning care. As we accumulate more information on complications, individualized risk-benefit assessments will become progressively meaningful for patients.