Annual Meeting Home
Final Program
Past & Future Meetings
 

 

Back to Annual Meeting Program


Risk Factors in Maxillofacial Fractures: Evaluating Clinical Predictors of Complication and Revision
J. Bradford Hill, M.D.1, Jennifer L. Best, B.A.1, Kevin W. Sexton, M.D.1, Melissa A. Mueller, B.A.1, Ashit Patel, MBChB, MRCS2, Gabriel A. Del Corral, M.D.1, Wesley P. Thayer, M.D., Ph.D.1, Oscar D. Guillamondegui, M.D., M.P.H.1, Kevin J. Kelly, M.D., D.D.S.1, R. Bruce B. Shack, M.D.1.
1Vanderbilt University, Nashville, TN, USA, 2Albany Medical Center, Albany, NY, USA.

BACKGROUND: It is unclear whether certain risk factors predict outcome in maxillofacial fractures. This study was designed to compare demographics, medical comorbidity and injury characteristics to define variables that contribute to operative, medical and cosmetic complication.
MEHODS: A retrospective review encompassed all facial fractures managed with internal fixation at an academic medical center from January 2005 to August 2011. Data included demographic, medical comorbidity, socioeconomic, operative and clinical information. The Trauma Registry of the American College of Surgeons (TRACS) yielded injury characteristics among trauma admissions. The primary outcome was revision, defined as reoperation in the setting of complication, determined by individual chart review of the clinical course and specific indication. A Social Security Death Index cross-reference identified incidence of mortality. Statistical analysis utilized chi-squared and logistic regression.
RESULTS: This review identified 2085 patients with maxillofacial fractures managed by internal fixation. The overall rate of revision was 4.6%[96/2085], and was predicted by advanced age (p = 0.016) and diabetes (odds ratio [OR] 3.0, 95% confidence interval [CI] 1.7-5.2, p < 0.001). Diabetics were also significantly more likely to experience nonunion (p = 0.039) and cosmetic revision (p = 0.021). There were 955(46%) facial fractures among trauma admissions with a revision rate of 3.5%[34/955]. Diabetics remained significantly more likely to undergo revision among the trauma population (OR 4.485, 95% CI 1.6-12.2, p < 0.001). Overall, 1-year mortality was 2.8%[59/2085], significantly higher among patients over 65 years of age (18% vs. 1.1%, p < 0.001) and diabetics (6.7% vs. 2.5%, p < 0.001), with a rate of 24%[8/33] among patients with both risk factors.
CONCLUSIONS: Overall, advanced age and diabetes were the most significant risk factors predictive of both complication and mortality among maxillofacial fractures treated with internal fixation. This emphasizes the importance of meticulous preoperative planning and diligent postoperative monitoring and medical optimization to offset a considerable risk of complication and revision.


Back to Annual Meeting Program

 

 
© 2024 Northeastern Society of Plastic Surgeons. All Rights Reserved. Privacy Policy.