Christian Ashton, Sun Beatrice J, Khoshab Nima, Grigorian Areg, Cantwell Christina Y, Melucci Sean A, Hu Allison C, Kuza Catherine M, Lekawa Michael E, Nahmias Jeffry
Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, CA, USA.
Department of Surgery, Stanford University, Palo Alto, CA, USA.
Craniomaxillofac Trauma Reconstr. 2022 Jun;15(2):111-121. doi: 10.1177/19433875211020615. Epub 2021 Jun 3.
Retrospective cohort.
Traumatic facial fractures (FFs) often require specialty consultation with Plastic Surgery (PS) or Otolaryngology (ENT); however, referral patterns are often non-standardized and institution specific. Therefore, we sought to compare management patterns and outcomes between PS and ENT, hypothesizing no difference in operative rates, complications, or mortality.
We performed a retrospective analysis of patients with FFs at a single Level I trauma center from 2014 to 2017. Patients were compared by consulting service: PS vs. ENT. Chi-square and Mann-Whitney-U tests were performed.
Of the 755 patients with FFs, 378 were consulted by PS and 377 by ENT. There was no difference in demographic data ( > 0.05). Patients managed by ENT received a longer mean course of antibiotics (9.4 vs 7.0 days, = 0.008) and had a lower rate of open reduction internal fixation (ORIF) (9.8% vs. 15.3%, = 0.017), compared to PS patients. No difference was observed in overall operative rate (15.1% vs. 19.8%), use of computed tomography (CT) imaging (99% vs. 99%), time to surgery (65 vs. 55 hours, = 0.198), length of stay (LOS) (4 vs. 4 days), 30-day complication rate (10.6% vs. 7.1%), or mortality (4.5% vs. 2.6%) (all > 0.05).
Our study demonstrated similar baseline characteristics, operative rates, complications, and mortality between FFs patients who had consultation by ENT and PS. This supports the practice of allowing both ENT and PS to care for trauma FFs patients, as there appears to be similar standardized care and outcomes. Future studies are needed to evaluate the generalizability of our findings.
回顾性队列研究。
创伤性面部骨折（FFs）通常需要整形外科（PS）或耳鼻喉科（ENT）的专科会诊；然而，转诊模式往往不标准化且因机构而异。因此，我们试图比较PS和ENT之间的治疗模式及结果，假设手术率、并发症或死亡率无差异。
我们对2014年至2017年在一家一级创伤中心的FFs患者进行了回顾性分析。根据会诊科室对患者进行比较：PS组与ENT组。进行了卡方检验和曼-惠特尼-U检验。
在755例FFs患者中，378例由PS会诊，377例由ENT会诊。人口统计学数据无差异（>0.05）。与PS组患者相比，ENT组管理的患者接受抗生素治疗的平均疗程更长（9.4天对7.0天，P = 0.008），切开复位内固定（ORIF）率更低（9.8%对15.3%，P = 0.017）。在总体手术率（15.1%对19.8%）、计算机断层扫描（CT）成像的使用（99%对99%）、手术时间（65小时对55小时，P = 0.198）、住院时间（LOS）（4天对4天）、30天并发症发生率（10.6%对7.1%）或死亡率（4.5%对2.6%）方面均未观察到差异（所有P>0.05）。
我们的研究表明，ENT和PS会诊的FFs患者在基线特征、手术率、并发症和死亡率方面相似。这支持了允许ENT和PS都照顾创伤性FFs患者的做法，因为似乎有相似的标准化治疗和结果。未来需要进行研究以评估我们研究结果的普遍性。
