Do We Need Safety Nets for Outsourced Computer-Aided Orthognathic Planning? A Two-Center Analysis

Purpose: While the accuracy, cost-effectiveness, and time-efficiency of computer-aided orthognathic surgical planning (CAOP) have been studied, little is known about the influence of logistical factors of outsourced CAOP (OS-CAOP) on patient care. The purpose of this study was to investigate the limitations of OS-CAOP and their effect on treatment planning workflow and surgical outcomes. Methods: A retrospective cross-sectional study was designed involving subjects who had undergone orthognathic surgery using CAOP from 2 academic oral and maxillofacial surgery centers in South Korea (Kyungpook National University, KNU) and the United States (University of Illinois Chicago, UIC) over an 8-year period. The primary predictor variable was use of modifications or alternatives to OS-CAOP. The primary outcome variable was the frequency of planning changes due to reasons that may have affected outcomes. Covariates included age and sex. Descriptive statistics was used, in addition to a chi-square test to analyze differences among categorical variables. Results: Of a total of 642 eligible subjects in both centers, 5.8% used alternatives to OS-CAOP. 78.4% of these were due to reasons that may have affected outcomes (P <.001), representing 4.5% of all cases. The frequency of the need for OS-CAOP alternatives was identical in both centers (5.8%), but the specific reasons varied, with KNU having mostly plan-related changes (38.1% of alternatives), and UIC with more access and education-related reasons (68.8% of alternatives). At KNU, 71.4% of all alternatives were by repeat OS-CAOP, whereas at UIC, all were by in-house CAOP (IH-CAOP). Conclusions: In 2 major academic oral and maxillofacial surgery centers in South Korea and the United States, a substantial portion of OS-CAOP required pre-surgical modification, or use of alternatives. Most of the changes were for reasons that could potentially impact outcomes, prompting the need to consider establishing a “safety net” plan compatible with individual clinician's practice setting and healthcare system.