NESPS - National Analysis of Surgical Intervention for Orbital Floor Fractures

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National Analysis of Surgical Intervention for Orbital Floor Fractures - Implications on Early vs Late Repair
Chen Shen^*^¹, Jennifer K. Shah^², Rahim Nazerali^³, Michael Matthew^¹
^¹Plastic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH; ^²Geisel School of Medicine, Hanover, NH; ^³Stanford Plastic Surgery, Palo Alto, CA

Introduction:
Timing of intervention for patients with orbital floor fractures is controversial. Some data suggest those who present with diplopia and/or enophthalmos have improved outcomes with surgery within 2 weeks of injury, while other studies demonstrate that patients fared equally well even if observed for greater than 2 weeks until repair. Our study aims to evaluate national trends and safety outcomes of timing of intervention for isolated orbital floor fractures.

Materials:
From the Merative™ MarketScan^® Research Databases, patients were queried from January 2007 to December 2021. ICD-9, ICD-10, and CPT codes were used to identify patients with orbital floor fractures, without entrapment, intracranial injuries, other face/skull fractures, or ocular injuries. Rates of enophthalmos and diplopia were examined relative to timing of intervention (no repair, early repair [≤2 weeks], or late repair [>2 weeks]).

Results:
Of the 73,570 patients identified, 11,136 were included in the study. Mean age was 39 years. 266 (2.4%) presented with enophthalmos and 725 (6.5%) presented with diplopia. 8548 (76.8%) underwent no, 2159 (19.4%) underwent early, and 429 (3.9%) underwent late repair. Intervention was correlated with presentation of enophthalmos (OR 8.40, p < 0.001) and diplopia (OR 4.07, p < 0.001). Late vs. early repair was not associated with presentation of enophthalmos (OR 0.64, p = 0.056) or diplopia (OR 0.73, p = 0.062). At one year follow-up, enophthalmos and diplopia were diagnosed in 111 (1.3%) and 404 (4.7%) patients who underwent no, 94 (4.4%) and 297 (13.8%) patients who underwent early, and 47 (5.7%) and 94 (11%) patients who underwent late repair, respectively. There was no differences in rates of re-repair following early or late repair (p = 0.453).

Conclusion:
Decision to intervene on orbital floor fractures is strongly correlated with symptoms on initial presentation. From our analysis, rates of enophthalmos, diplopia, and re-repair were similar at one-year follow-up. Therefore, there were no difference in outcomes between early and late repair.

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