Resident, Oral & Maxillofacial Surgery, Massachusetts General Hospital and Clinical Fellow, Harvard School of Dental Medicine, Boston, MA.
Instructor, Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA.
J Oral Maxillofac Surg. 2021 Dec;79(12):2507-2518. doi: 10.1016/j.joms.2021.03.018. Epub 2021 Mar 26.
Timing of mandibular fracture repair has long been debated. The purpose of the present study was to assess the incidence of postoperative inflammatory complications (POICs) following open repair of mandibular fractures managed non-urgently in the outpatient setting versus urgently in the inpatient setting.
The authors utilized the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to enroll a sample of patients with mandibular fractures who underwent open repair. The primary independent variable was treatment protocol: outpatient (elective) versus inpatient (urgent/non-elective). The primary dependent variable was POIC (yes/no). Descriptive, bivariate, and multiple logistic regression statistics were utilized to evaluate the relationship between treatment protocol and POICs.
The study cohort was comprised of 1,848 subjects with 1,134 outpatients and 714 inpatients. The incidence of POICs was 6.53% for the outpatient group compared to 8.96% for the inpatient group, with no significant difference between groups (P= .052). However, subjects treated as inpatients were 1.51 times more likely to experience any complication (P = .008) due to an increase in non-POICs (P = .028), in particular urinary tract infections (P = .035). After adjusting for age, hypertension requiring medical treatment, and smoking, classification as ASA II (P = .046, OR = 2.21, 95% CI 1.01 to 4.83), ASA III (P = .020, OR = 2.88, 95% CI 1.18 to 7.02), diabetes (P = 0.004, OR = 3.11, 95% CI 1.43 to 6.74), and preoperative hematocrit (P = 0.010, OR = 0.950, 95% CI 0.913 to 0.988) were independent predictors of POICs. Length of stay was 0.83 ± 2.61 days compared to 2.36 ± 3.63 days for the outpatient and inpatient groups, respectively (P ≤ .001).
There was no significant difference in POICs between patients treated as outpatients versus inpatients, though outpatients had fewer non-POICs and a shorter length of hospital stay.
下颌骨骨折修复的时机一直存在争议。本研究的目的是评估在门诊非紧急情况下和住院部紧急情况下接受开放式下颌骨骨折修复的患者的术后炎症性并发症（POIC）发生率。
作者利用美国外科医师学院国家外科质量改进计划（ACS-NSQIP）数据库纳入了一组接受开放式修复的下颌骨骨折患者。主要的独立变量是治疗方案：门诊（择期）与住院部（紧急/非择期）。主要的因变量是 POIC（是/否）。采用描述性、双变量和多逻辑回归统计来评估治疗方案与 POIC 之间的关系。
研究队列由 1848 名患者组成，其中 1134 名门诊患者和 714 名住院患者。门诊组的 POIC 发生率为 6.53%，住院组为 8.96%，两组之间无显著差异（P=.052）。然而，住院患者发生任何并发症的可能性是门诊患者的 1.51 倍（P=.008），这主要是由于非 POIC 的增加（P=.028），特别是尿路感染（P=.035）。在校正年龄、需要药物治疗的高血压和吸烟后，ASA 分级 II（P=.046，OR=2.21，95%CI 1.01 至 4.83）、ASA 分级 III（P=.020，OR=2.88，95%CI 1.18 至 7.02）、糖尿病（P=0.004，OR=3.11，95%CI 1.43 至 6.74）和术前红细胞压积（P=0.010，OR=0.950，95%CI 0.913 至 0.988）是 POIC 的独立预测因子。门诊组和住院组的住院时间分别为 0.83±2.61 天和 2.36±3.63 天（P ≤.001）。
在门诊患者和住院患者中，POIC 无显著差异，尽管门诊患者的非 POIC 更少，住院时间更短。
