Comparison of Clinical, Anesthetic, and Perioperative Outcomes Between Single-Jaw and Bimaxillary Orthognathic Surgery: A Retrospective Analysis of 499 Cases

OBJECTIVE: Orthognathic surgery involves complex perioperative management due to prolonged operative time, shared airway challenges, and potential complications. This study aimed to evaluate the impact of surgical scope (single-jaw versus bimaxillary) on perioperative outcomes, hemodynamics, length of hospital stay (LOS), and complications. MATERIALS AND METHODS: A retrospective cohort of 499 patients undergoing orthognathic surgery between 2017 and 2025 was analyzed: single-jaw (n=81) and bimaxillary (n=418) groups. Demographics, American Society of Anesthesiologists (ASA) status, the Index of Complexity, Outcome and Need (ICON) scores, anesthesia and surgical durations, intraoperative vitals, LOS, blood transfusion requirements, and perioperative complications were compared. Significance was set at a P value <0.05. The study was approved by the Ethics Committee of Suleyman Demirel University, Faculty of Medicine, and conducted in accordance with the Declaration of Helsinki. RESULTS: There were no significant differences in age, height, or weight between groups. Bimaxillary surgery had longer anesthesia and operative times (P=0.001) and LOS (P=0.034). Systolic blood pressure at 120 minutes was lower in the bimaxillary group (P=0.012), reflecting controlled hypotensive anesthesia. Complication and transfusion rates were low and similar. A weak negative correlation was observed between weight and LOS (r=-0.131; P=0.003). CONCLUSIONS: Bimaxillary surgery is associated with longer operative and anesthesia times and hospital stay, but shows a safety profile comparable to single-jaw procedures. With proper anesthesia and surgical planning, it can be safely performed in young, mostly ASA I to II patients.