Icahn School of Medicine at Mount Sinai, New York, NY.
Division of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, MD.
J Craniofac Surg. 2022;33(8):2573-2577. doi: 10.1097/SCS.0000000000008825. Epub 2022 Aug 2.
The present study sought to evaluate whether the mFI-5 and modified Charlson Comorbidity Index (mCCI) are stronger predictors of 30-day postoperative complications after open reduction of facial fractures compared with historic risk proxies.
A retrospective review of the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) database was conducted to investigate patients who underwent open reduction facial fracture surgery between 2013 and 2018. Risk factors including age, smoking status, body mass index (BMI), comorbidities, and American Society of Anesthesiologists (ASA) class were extracted for each patient. The mFI-5 score and mCCI score were calculated based on this data. Univariate logistic regressions were performed (P<0.05).
A total of 2667 cases were included. Of these, 2131 (80%) were male. The strongest predictors for overall 30-day complications and complication severity were ASA class ≥3 (Odds Ratio [OR]=3.34), comorbidities ≥2 (OR=2.78), mCCl score ≥2 (OR=2.19), and mFI-5 ≥1 (OR=1.96). Smoking status and BMI were not strong predictors of total complications or complication severity. Age was found to be a statically significant, but low-impact, predictor of complications, and severity (OR=1.02, P<0.001). The only significant predictors of surgical site infections (SSI) were smoking status (OR=1.56) and ASA class ≥3 (OR=2.40). mFI-5 ≥1 was a significant predictor of hospital readmission. BMI was not associated with any increased risk.
The mCCI and mFI-5 are statistically significant predictors of total complications and complication severity in open reduction of facial fracture repair, and thus provide a tool to inform decision making and improve care. Smoking status may increase risk for SSIs following facial fracture repair.
本研究旨在评估 mFI-5 和改良 Charlson 合并症指数（mCCI）是否比历史风险指标更能预测面部骨折切开复位术后 30 天的术后并发症。
对美国外科医师学会全国手术质量改进计划（ACS-NSQIP）数据库进行回顾性分析，调查 2013 年至 2018 年间接受切开复位面部骨折手术的患者。为每位患者提取年龄、吸烟状况、体重指数（BMI）、合并症和美国麻醉医师协会（ASA）分级等危险因素。根据这些数据计算 mFI-5 评分和 mCCI 评分。进行单变量逻辑回归（P<0.05）。
共纳入 2667 例患者，其中 2131 例（80%）为男性。总体 30 天并发症和并发症严重程度的最强预测因素为 ASA 分级≥3（优势比[OR]=3.34）、合并症≥2（OR=2.78）、mCCI 评分≥2（OR=2.19）和 mFI-5≥1（OR=1.96）。吸烟状况和 BMI 不是总并发症或并发症严重程度的强预测因素。年龄是并发症和严重程度的统计学显著但影响较小的预测因素（OR=1.02，P<0.001）。手术部位感染（SSI）的唯一显著预测因素是吸烟状况（OR=1.56）和 ASA 分级≥3（OR=2.40）。mFI-5≥1 是住院再入院的显著预测因素。BMI 与任何增加的风险无关。
mCCI 和 mFI-5 是面部骨折切开复位术总并发症和并发症严重程度的统计学显著预测因素，因此提供了一种工具来辅助决策制定并改善护理。吸烟状况可能会增加面部骨折修复后 SSI 的风险。
