Department of Surgery, Division of Otolaryngology, Yale School of Medicine, New Haven, CT.
Case Western Reserve University, School of Medicine, Cleveland, OH.
J Craniofac Surg. 2020 Jul-Aug;31(5):1232-1237. doi: 10.1097/SCS.0000000000006425.
We aimed to utilize the 2010 to 2017 National Surgical Quality Improvement Program to evaluate the epidemiology and efficacy of facial fracture repairs, specifically comparing multiple fracture site repairs (MFR) compared to single fracture site repairs (SFR). Of 4739 patients, 718 (15.2%) were found to have undergone MFR. A total of 577 (80.4%) of the MFRs involved the midface only. A total of 2114 (52.6%) of the SFRs were mid-face fractures, while 1825 (45.4%) involved the lower-face and only 82 (2.0%) involved the upper-face. The most frequent MFR was combined orbital and malar/zygoma repair (230 cases [32.0%]). When comparing MFR and SFR of the mid-face, MFR patients were more commonly male, White, operated on by plastic surgeons, presented with contaminated wounds, and active smokers. While MFRs were associated with a longer operative time (P < 0.001) and a longer postoperative hospital stay (P < 0.001), there were no differences in reoperation or readmission. Overall, complication rates were low, but slightly higher in the mid-face MFR group (1.4% in mid-face SFR and 3.0% in mid-face MFR; P = 0.019). Sub-analysis of mid-face only MFRs and middle-lower-face MFRs revealed no difference in postoperative complication rates (3.0% and 7.0%, respectively; P = 0.071). The data presented suggests that MFR are a relatively common occurrence. Although plastic surgeons perform MFRs more frequently, it is currently unclear whether the underlying reason is a product of differences in training, coding patterns, or referral patterns. Though MFRs require more hospital resources, complications rates are low. This will help manage patient expectations and guide patient counseling before surgery, as well as help to plan postoperative care.
我们旨在利用 2010 年至 2017 年全国外科质量改进计划评估面部骨折修复的流行病学和疗效，特别是比较多处骨折部位修复（MFR）与单一骨折部位修复（SFR）。在 4739 名患者中，有 718 名（15.2%）患者行 MFR。共有 577 例（80.4%）MFR 仅涉及中面部。共有 2114 例（52.6%）SFR 为中面部骨折，1825 例（45.4%）涉及下脸，仅有 82 例（2.0%）涉及上脸。最常见的 MFR 是眶部和颧骨/颧弓联合修复（230 例[32.0%]）。比较中面部 MFR 和 SFR 时，MFR 患者更常见于男性、白人、由整形外科医生手术、有污染伤口和吸烟者。虽然 MFR 与较长的手术时间（P < 0.001）和较长的术后住院时间（P < 0.001）相关，但再手术或再入院率没有差异。总的来说，并发症发生率较低，但在中面部 MFR 组稍高（中面部 SFR 为 1.4%，中面部 MFR 为 3.0%；P = 0.019）。中面部 MFR 和中下部面部 MFR 的亚分析显示，术后并发症发生率无差异（分别为 3.0%和 7.0%；P = 0.071）。目前的数据表明，MFR 较为常见。尽管整形外科医生更频繁地进行 MFR，但目前尚不清楚其根本原因是培训、编码模式还是转诊模式的差异所致。虽然 MFR 需要更多的医院资源，但并发症发生率较低。这将有助于管理患者的期望并指导手术前的患者咨询，以及帮助规划术后护理。
