Christensen Brian J, Mercante Donald E, Neary John P, King Brett J
Resident, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA.
Professor, Department of Biostatistics, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA.
J Oral Maxillofac Surg. 2017 Apr;75(4):787.e1-787.e8. doi: 10.1016/j.joms.2016.12.003. Epub 2016 Dec 11.
The purpose of the present study was to identify the risk factors for major complications developing during the operative treatment of mandibular fractures.
We conducted a retrospective medical record review of patients who had undergone open reduction, internal fixation of mandibular fractures from August 1, 2012 to December 31, 2014 at a large, urban teaching hospital and level 1 trauma center. The outcome variable of interest was major complications, defined as the occurrence of any one of the following events: hospital readmission, return to the operating room, and a prolonged, unexpected postoperative stay. Multiple demographic, social, medical, injury-related, and treatment-related variables were recorded during the medical record review. The relationships between these variables and our outcome variable were analyzed using univariate and multivariable logistic regression analyses.
A total of 317 patients met the inclusion criteria. The hospital readmission rate was 7.2%, the reoperation rate was 9.5%, and the rate of unplanned, prolonged admission was 0.6%, for a total major complication rate of 11.4%. Eight variables reached statistical significance in their association with the occurrence of major complications. These were the presence of medical comorbidities, a diagnosis of depression, a diagnosis of a psychiatric disorder, incarceration, interpersonal violence as a mechanism of injury, the presence of a left angle fracture, the removal of a tooth in the line of fracture, and patient noncompliance. On multivariable analysis, patient noncompliance, depression, the presence of a left angle fracture, and the removal of a tooth in the line of fracture continued to have statistically significant associations with the occurrence of major complications.
The identification of risk factors for the development of complications in mandibular trauma is a primary concern for surgeons in the modern healthcare system. The present study identified a number of variables significantly associated with an increased risk of the occurrence of major complications, and special consideration should be given to patients with these risk factors.
本研究旨在确定下颌骨骨折手术治疗期间发生主要并发症的危险因素。
我们对2012年8月1日至2014年12月31日在一家大型城市教学医院及一级创伤中心接受下颌骨骨折切开复位内固定术的患者进行了回顾性病历审查。感兴趣的结局变量为主要并发症，定义为发生以下任何一种事件：再次入院、返回手术室以及术后意外延长住院时间。在病历审查期间记录了多个人口统计学、社会、医学、损伤相关及治疗相关变量。使用单因素和多因素逻辑回归分析来分析这些变量与我们的结局变量之间的关系。
共有317例患者符合纳入标准。再次入院率为7.2%，再次手术率为9.5%，计划外延长住院率为0.6%，总主要并发症发生率为11.4%。八个变量与主要并发症的发生存在统计学显著关联。这些变量包括存在内科合并症、抑郁症诊断、精神障碍诊断、监禁、人际暴力作为损伤机制、存在左角骨折、骨折线上牙齿拔除以及患者不依从。多因素分析显示，患者不依从、抑郁症、存在左角骨折以及骨折线上牙齿拔除与主要并发症的发生仍具有统计学显著关联。
在现代医疗保健系统中，确定下颌骨创伤并发症发生的危险因素是外科医生的首要关注点。本研究确定了一些与主要并发症发生风险增加显著相关的变量，对于有这些危险因素的患者应给予特别关注。
