An Analysis of Independent Variables Affecting Surgical Outcomes in Patients Undergoing Repair of Maxillofacial Trauma: An American College of Surgeons National Surgical Quality Improvement Program Study

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Abstract

Introduction:

Facial fractures, from straightforward closed nasal reductions to complex pan facial fractures, are commonly encountered in the Plastic Surgical community. However, very little has been discussed in the literature regarding the outcomes of facial fractures relating to contributing factors. Our aim was to evaluate a battery of independent variables in order to identify, which, if any, factors correlate with suboptimal outcomes in patients who have undergone facial fracture surgery.

Methods:

Under the data use agreement of the American College of Surgeons public use files of the NSQIP, patients involving repair of facial fractures, Current Procedural Terminology codes 21310 to 21470 inclusive, were queried. The outcomes examined included: wound dehiscence, superficial surgical site infection, deep surgical site infection, readmission, open wound/wound infection and return to the operating room.

Results:

There were 2069 facial fracture patients in the National Surgical Quality Improvement Program datasets (2005–2013). Thirteen perioperative risk factors and patient comorbidities were evaluated for correlation with the 6 outcomes. Of the 6 outcomes evaluated, open wound/wound infection was the most prevalent outcome (6%). Factors statistically significant for presence of open wound/wound infection were American Society of Anesthesiology classification (P = 0.002), presence of bleeding disorder (P = 0.008), emergency patient (P = 0.001), chronic alcohol use (P = 0.002), and chronic steroid use (P = 0.034).

Discussion:

Several factors correlated with presence of an open wound/wound infection; however, variables such as diabetes and active tobacco use, which are often thought to contribute to wound infections, were shown to be statistically nonsignificant. Although this study was limited by its observational nature, these data may indicate a change in perception of the factors correlated with wound infections.

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