A Retrospective Analysis of Delay to Treatment in Mandibular Fractures and its Impact on Surgical and Financial Outcomes
Bernardino M. Mendez, MD1, Brendan D. O'Donnell, B.S.1, Kevin J. Robertson, DDS1, Michael V. Chiodo, MD2, Parit A. Patel, MD1.
1Loyola University Medical Center, Maywood, IL, USA, 2New York University, New York, NY, USA.
Purpose: To analyze the impact of a delay to treatment of mandibular fractures on surgical outcomes and patient costs, and to determine patient characteristics associated with a delay to treatment.
Methods: Patients who underwent open reduction procedures for mandibular fractures were identified from the 2007-2011 Healthcare Cost and Utilization Project California State Inpatient Database. Two cohorts were compared: patients who experienced a delay to surgical treatment from admission (2 or more days), and those who did not. Patient demographics, comorbidities, and postoperative outcomes, including complications, readmissions, and length of stay, were compared between groups using multivariable logistic regression.
Results: A total of 6,426 patients were included in the study, 19.2 percent of these cases (n = 1,239) demonstrated a delay to surgical repair. These patients were more likely to be older (p<0.001), female (p<0.001), admitted on the weekend (p<0.002), and to suffer from comorbidities including alcohol/drug abuse (p<0.001), chronic hypertension (p<0.001), and chronic lung disease (p<0.05). However, controlling for patient characteristics/comorbidities, a delay to treatment was still shown to significantly contribute to higher complication rates (aOR 1.84; p<0.003), mortality (aOR 1.71; p<0.001), and 60-day readmission rates (aOR 1.60; p<0.001). These patients also experienced an increased length of stay (mean 9.73 days vs. 2.88 days; p<0.001).
Conclusions: Delay to treatment for mandibular fractures greater than 2 days results in a substantial increase in postoperative complications, readmissions, and hospital stay. These data suggest that reducing the time period between admission and surgery can improve surgical outcomes and reduce complication rates.
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