Ali Barkat, Choi EunHo Eunice, Barlas Venus, Morrell Nathan T
Department of Surgery, Division of Plastic and Reconstructive Surgery.
Clinical and Translational Science Center.
J Craniofac Surg. 2021 Jun 1;32(4):1338-1340. doi: 10.1097/SCS.0000000000007387.
Patients with isolated facial fractures requiring operative fixation can be managed on an inpatient or outpatient basis. The goal of this study was to compare the safety of each approach using a large multi-institutional database.
The American College of Surgeons' National Surgical Quality Improvement Project was reviewed for facial fractures between 2005 and 2018. Groups were identified using inpatient and outpatient status as designated in the database. Patients who required additional procedures, concurrent procedures, or other emergency procedures were excluded. Descriptive statistics were used for group comparisons and logistic regression models were used to identify risk factors for complications.
We identified 4240 patients who underwent operative fixation of isolated facial fractures. The majority of these cases (67.9%) were done on an outpatient basis. Compared to those in the outpatient group, patients in the inpatient group were older, had more medical comorbidities, had higher wound class, and had higher American Society of Anesthesiologists class. Complication (5.9% versus 2.3%), reoperation (4.3% versus 1.7%), and readmission (5.7% versus 2.5%) rates were all higher in the inpatient group (P < 0.01). By logistic regression analysis, the odds ratios for complications, reoperation, and readmission were higher in the inpatient group. After adjusting for imbalanced preoperative patient characteristics, the increased risk of complications [odds ratio (OR) = 1.728, confidence interval (CI) 1.146-2.606, P = 0.01] and the increased risk of reoperation (OR = 2.302, CI 1.435-3.692, P = 0.01) in the inpatient group persisted, while the risk of readmission (OR = 1.684, CI 0.981-2.891, P = 0.06) no longer showed statistical significance between the inpatient and outpatient groups.
Inpatient operative management of isolated facial fractures is associated with an increased risk of complications and a 2-fold increased risk of reoperation, though no increased risk of readmission.
孤立性面部骨折需要手术固定的患者可采用住院或门诊治疗。本研究的目的是使用一个大型多机构数据库比较每种治疗方法的安全性。
回顾美国外科医师学会国家外科质量改进项目2005年至2018年间的面部骨折病例。根据数据库中指定的住院和门诊状态对患者进行分组。排除需要额外手术、同期手术或其他急诊手术的患者。采用描述性统计进行组间比较，并使用逻辑回归模型确定并发症的危险因素。
我们确定了4240例行孤立性面部骨折手术固定的患者。这些病例中的大多数（67.9%）是在门诊进行的。与门诊组患者相比，住院组患者年龄更大，有更多的内科合并症，伤口分级更高，美国麻醉医师协会分级更高。住院组的并发症发生率（5.9%对2.3%）、再次手术率（4.3%对1.7%）和再入院率（5.7%对2.5%）均更高（P<0.01）。通过逻辑回归分析，住院组并发症、再次手术和再入院的比值比更高。在对术前患者特征不均衡进行调整后，住院组并发症风险增加[比值比（OR）=1.728，置信区间（CI）1.146 - 2.606，P = 0.01]和再次手术风险增加（OR = 2.302，CI 1.435 - 3.692，P = 0.01）仍然存在，而住院组和门诊组之间的再入院风险（OR = 1.684，CI 0.981 - 2.891，P = 0.06）不再具有统计学意义。
孤立性面部骨折的住院手术治疗与并发症风险增加以及再次手术风险增加两倍相关，尽管再入院风险没有增加。
