1
|
Kannari L, Marttila E, Oksa M, Furuholm J, Snäll J. Non-Surgical Site-Related Complications in Mandibular Fracture Surgery - A Problem of Elderly Patients? J Oral Maxillofac Surg 2024; 82:47-55. [PMID: 38164998 DOI: 10.1016/j.joms.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/29/2023] [Accepted: 10/07/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Scientific evidence of nonsurgical site-related complications in mandibular fracture patients is limited. PURPOSE The purpose was to measure the frequency of nonsurgical site complications in patients with mandible fractures, describe the types of complications, and identify the risk factors associated with these complications. STUDY DESIGN, SETTING, SAMPLE A retrospective cohort study was conducted at the Helsinki University hospital between 2018 and 2021. Patients undergoing surgery with open reduction and internal fixation of mandibular fracture(s) were evaluated. Patients under 16 years of age were excluded. PREDICTOR VARIABLE Primary predictor variable was age. Patient-related predictor variables were sex, long-term disease(s), smoking, and alcohol and/or drug abuse. Injury and fracture-related variables were injury mechanism, type and site of facture, combined craniofacial fracture(s), and associated injury(s). MAIN OUTCOME VARIABLE(S) The primary outcome variable was nonsurgical site-related postoperative complication. The secondary outcome variable was type of complication. COVARIATES Not applicable. ANALYSES The main outcome variable was cross tabulated for pairwise comparisons with predictor variables. Multivariate logistic regression was performed for statistically significant (P < .05) variables. RESULTS The data included 314 patients (age range: 16 to 89 years; mean age: 38 years old; median age: 33 years old); most (78.3%) were men. Nonsurgical site-related postoperative complications occurred in 6.7% of patients. The most common complication type was pulmonary complication (36.0%), followed by urinary complication (20.0%) and general infection (16.0%). Nonsurgical site-related postoperative complications were most likely to occur in patients who were elderly (adjusted odds ratio [aOR] 5.55; 95% CI 1.92 to 16.21; P = .002), had combined craniofacial fractures (aOR 2.92; 95% CI 1.06 to 8.03; P = .038), and abused alcohol or drugs (aOR 4.51; 95% CI 1.70 to 11.96; P = .003). Pulmonary complications occurred more often in elderly patients, whereas urinary complications were more common in younger patients. CONCLUSIONS AND RELEVANCE The types of nonsurgical site complications in mandibular fracture patients increase and vary according to the patient's age. Awareness of possible complications related to different age groups helps anticipate and identify these in clinical work, and to consider the overall treatment of the patient beyond the fracture.
Collapse
Affiliation(s)
- Leena Kannari
- Researcher, Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Emilia Marttila
- Consultant, Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marko Oksa
- Researcher, Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jussi Furuholm
- Researcher, Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Johanna Snäll
- Associate Professor (tenure-track), Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
2
|
Yu AJ, Collet C, Su P, Ference E, Moayer R. Ambulatory Orbital Fracture Repair: An Analysis of ER Visits After Surgery From a Multistate Study. Otolaryngol Head Neck Surg 2023; 169:1445-1454. [PMID: 37497605 DOI: 10.1002/ohn.428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 06/05/2023] [Accepted: 06/25/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVE To determine the 30-day postoperative emergency room (ER) visit rate following ambulatory orbital fracture repair with same-day discharge, and the causes and risk factors associated with ER visit. STUDY DESIGN Database study. SETTING State Ambulatory Surgery and Services Database (SASD) and State Emergency Department Database (SEDD) for California, New York, and Florida for 2011. METHODS We identified orbital fracture repair procedures among adults from the SASD, which was linked to the SEDD to identify the incidence and causes of ER visits within 30 days. Univariate and multivariable logistic regression models were used to determine the factors associated with ER visit. RESULTS Among 762 patients, the 30-day postoperative ER visit rate was 4.5%. Most ER visits (58.9%) occurred during the first week after surgery. The most common reasons for ER visits were related to pain, swelling, headache, dizziness, and fatigue (29.4%), followed by ophthalmologic etiologies including visual disturbances and infection of the eye (14.7%). There was no case of retrobulbar hematoma. In the multivariate analysis, patients living in Florida were at a significantly higher risk for ER visit compared to those in California (odds ratio: 4.48 [1.43-14.10], p = .010). CONCLUSION Ambulatory orbital fracture repair appears to be safe. Common reasons for ER visit included pain, swelling, and ophthalmic symptoms. An increased risk for ER visit was seen with certain geographic regions but not with medical comorbidities or concurrent facial fractures or procedures.
Collapse
Affiliation(s)
- Alison J Yu
- Tina and Rick Caruso Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California, USA
| | - Casey Collet
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Peiyi Su
- Tina and Rick Caruso Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California, USA
| | | | - Roxana Moayer
- Tina and Rick Caruso Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California, USA
| |
Collapse
|
3
|
Khandalavala KR, Boochoon K, Schissel M, Heckman WW, Geelan-Hansen K. Age, ASA-status, and Changes in NSQIP Comorbidity Indices Reporting in Facial Fracture Repair. Laryngoscope 2023; 133:2572-2577. [PMID: 36625305 DOI: 10.1002/lary.30559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/22/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To evaluate the impact of age and the American Society of Anesthesiologists (ASA) classification on post operative outcomes as well as the changes in the National Surgical Quality Improvement Program (NSQIP) database reporting of comorbidity index variables in patients with facial fractures. METHODS The NSQIP database was queried for facial fracture repair CPT codes between 2012 and 2019 and for modified Frailty Index (mFI) and modified Charlson Comorbidity Index (mCCI) variables between years 2006 and 2018. The predominant question analyzed two preoperative risk factors: patient and ASA classification. Chi-square analysis, Kruskal-Wallis, Mann-Whitney, Spearman correlation, and multivariable logistic regression were used to evaluate age and ASA classification with wound dehiscence, superficial surgical site infection (SSSI), deep wound infection (DWI), readmission status, and return to the OR. The reporting of indices variables was evaluated with descriptive statistics. CONCLUSION In this large database with univariate analysis, patients with a higher ASA classification and older patients experience significantly increased risks of readmission, return to the OR, and longer hospital stays. On multivariate analyses, ASA classes II, III, and IV are independently associated with increased risk of readmission and return to the OR, while controlling for patient age. The reporting of all mFI and mCCI variables were consistent from 2006 to 2010, but after 2011, there has been inconsistent or absent reporting of variables, therefore, conclusions on the impact of comorbidities on facial fracture repair are unreliable. LEVEL OF EVIDENCE 4 Laryngoscope, 133:2572-2577, 2023.
Collapse
Affiliation(s)
- Karl R Khandalavala
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kieran Boochoon
- Department of Otolaryngology and Head and Neck Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Makayla Schissel
- Department of Biostatics, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - W Wesley Heckman
- Department of Otolaryngology and Head and Neck Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Katie Geelan-Hansen
- Department of Otolaryngology and Head and Neck Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| |
Collapse
|
4
|
Atwez A, Antosz K, Cooper L, Le P, Mujadzic T, Seagle J, Mujadzic M, Friedman H. Preoperative Prophylactic Antibiotics in Mandibular Fractures and Surgical Site Infection. Ann Plast Surg 2023; 90:S326-S331. [PMID: 37332207 DOI: 10.1097/sap.0000000000003453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
BACKGROUND Compared with other facial fractures, mandibular fractures have the highest rate of postsurgical site infection. There is strong evidence to suggest that postoperative antibiotics do not reduce rates of surgical site infections (SSIs) regardless of duration. However, there are conflicting data in the literature regarding the role of prophylactic preoperative antibiotics in reducing rates of SSIs. This study reviews the rate of infections in patients who underwent mandibular fracture repair who received a course of preoperative prophylactic antibiotics compared with those who received no or 1 dose of perioperative antibiotics. METHODS Adult patients who underwent mandibular fracture repair at Prisma Health Richland between 2014 and 2019 were included in the study. A retrospective cohort review was conducted to determine the rate of SSI, comparing 2 groups of patients who underwent mandibular fracture repair. Patients who received more than 1 dose of scheduled antibiotics before surgery were compared with those who did not receive any antibiotic treatment before surgery or received only a single dose of antibiotics within 1 hour of incision time (perioperative antibiotics). The primary outcome was the rate of SSI between the 2 groups of patients. RESULTS There were 183 patients who received more than 1 dose of scheduled antibiotics before surgery and 35 patients who received a single dose of perioperative antibiotics or did not receive any antibiotics. The rate of SSI was not significantly different in the preoperative prophylactic antibiotics group (29.3%) compared with the patients who received a single perioperative dose or no antibiotics (25.0%). CONCLUSION Extended regimens of preoperative prophylactic antibiotics beyond a single dose at time of surgery do not reduce SSIs after surgical repair in mandibular fractures.
Collapse
Affiliation(s)
- Abdelaziz Atwez
- From the Division of Plastic Surgery, University of South Carolina School of Medicine/Prisma Health
| | | | | | - Paulina Le
- From the Division of Plastic Surgery, University of South Carolina School of Medicine/Prisma Health
| | - Tarik Mujadzic
- From the Division of Plastic Surgery, University of South Carolina School of Medicine/Prisma Health
| | | | - Mirsad Mujadzic
- From the Division of Plastic Surgery, University of South Carolina School of Medicine/Prisma Health
| | - Harold Friedman
- From the Division of Plastic Surgery, University of South Carolina School of Medicine/Prisma Health
| |
Collapse
|
5
|
Janaphan K, Hashem I, Smith C, Holmes S, Chatzopoulou D. Periodontal disease as a primary cause of surgical site infection in fractures of the mandible: is smoking a confounding variable? Br J Oral Maxillofac Surg 2022; 60:1424-1429. [PMID: 36400684 DOI: 10.1016/j.bjoms.2022.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/28/2022] [Accepted: 08/08/2022] [Indexed: 12/31/2022]
Abstract
Fractures of the mandible are common in contemporary oral and maxillofacial practice. Wound infection is the most common complication after open reduction and internal fixation, and the management of these is complex and costly in terms of morbidity to the patient, and in fiscal terms. Whilst numerous epidemiological studies implicate smoking, alcohol, drug use, and adverse behaviour, as well as fracture complexity and diabetes, as important risk factors, the role of periodontal disease is only occasionally mentioned and not formally investigated. The aim of this study therefore was to assess the presence of periodontal disease and its severity according to the 2018 EFP/AAP periodontitis case classification in patients with fractured mandibles who presented to a single level 1 trauma centre, and to look for a possible association with surgical site infection. A total of 305 patients were assessed retrospectively following open reduction and internal fixation via transoral incisions with load-sharing osteosynthesis. The postoperative infection rate was 22.95%. Multivariate and multiple logistic regression revealed that there was a strong association between periodontal staging and postoperative surgical site infection. Crucially, the study predicts that patients with severe periodontal disease (periodontal stage III and IV) are over seven times more likely to develop a wound infection than disease-negative individuals. This has implications for risk adjustment, prognostication, treatment planning, and postoperative care. Surprisingly in this study, cigarette smoking, an established risk factor in the pathogenesis of periodontal disease, did not achieve statistical significance, potentially conflicting with the established literature.
Collapse
Affiliation(s)
- K Janaphan
- Department of Periodontology Queen Mary University of London, United Kingdom
| | - I Hashem
- Department of Oral and Maxillofacial Surgery, Bartshealth NHS Trust, United Kingdom
| | - C Smith
- Department of Oral and Maxillofacial Surgery, Bartshealth NHS Trust, United Kingdom
| | - S Holmes
- Department of Oral and Maxillofacial Surgery, Bartshealth NHS Trust, United Kingdom
| | - D Chatzopoulou
- Department of Periodontology Queen Mary University of London, United Kingdom.
| |
Collapse
|
6
|
Al-Izzi T, Breeze J. How should we describe complications and stratify error in the treatment of facial fractures? A systematic review of the literature. Br J Oral Maxillofac Surg 2022; 60:1192-1195. [PMID: 36115744 DOI: 10.1016/j.bjoms.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/17/2022] [Indexed: 11/29/2022]
Abstract
Oral and maxillofacial (OMFS) facial fractures account for approximately 5%-10% of presentations to emergency departments in the UK. Although most trauma is treated operatively, different methods of surgery exist for the same clinical presentation and non- surgical management is in some cases appropriate. Analysis of patient morbidity is an essential component of clinical governance in surgery. OMFS units in the UK should hold regular morbidity and mortality (M&M) meetings, but no consensus exists for which cases should be discussed. For example, most units focus only on cases treated surgically, primarily unexpected returns to theatre. Finally, there is no agreed structure for describing how complications occur and a focus on terms such as error. The aim of this review is to help inform which patients should be discussed in M&M meetings based on existing scoring systems. A systematic review of the literature has been undertaken using the Preferred Reporting in Systematic Reviews and Meta-Analysis methodology. Databases searched were PubMed and Science Direct. Eleven unique papers and a companion article met the criteria and were analysed. Many M&M classification systems exist, but these systems are unsuited for maxillofacial purposes. There is a need for a novel system which is tailored to the specialty.
Collapse
Affiliation(s)
- Taha Al-Izzi
- Queen Elizabeth Hospital Birmingham, B15 2TH, UK.
| | - John Breeze
- Queen Elizabeth Hospital Birmingham, B15 2TH, UK
| |
Collapse
|
7
|
Can Frailty Indices Predict Surgical Risk in Open Reduction and Fixation of Facial Fractures? J Craniofac Surg 2022; 33:2573-2577. [DOI: 10.1097/scs.0000000000008825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/10/2022] [Indexed: 11/05/2022] Open
|
8
|
Non- surgical management of non- condylar mandible fractures. Br J Oral Maxillofac Surg 2022; 60:1224-1227. [DOI: 10.1016/j.bjoms.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/11/2022] [Indexed: 11/22/2022]
|
9
|
Ver Berne J, Politis C, Meyns J, Li J, Jacobs R. Prevalence of systemic conditions in an orthognathic surgery population: A 20-year single-center study. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:163-167. [PMID: 35428602 DOI: 10.1016/j.oooo.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/31/2021] [Accepted: 01/04/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe the prevalence and characteristics of patients with systemic conditions in an orthognathic surgery population. STUDY DESIGN A retrospective review was conducted of 1653 patients undergoing orthognathic surgery between 2001 and 2020. Patients were grouped per category of systemic condition and relevant information was retrieved from medical records. Clinical and perioperative characteristics were compared between patients with and without systemic conditions using χ2 tests and 95% confidence intervals. Age was compared using a cumulative logit model. RESULTS The proportion of patients with systemic conditions undergoing orthognathic surgery was 16% (272 of 1653 patients). Patients with systemic conditions were on average 6 years older than patients without systemic conditions (P < .001). Significant differences in age compared to healthy patients were found for endocrinological (12 years; 95% confidence interval [CI], 8-16 years), gastrointestinal (10 years; 95% CI, 3-18 years), pneumological (5 years; 95% CI, 2-13 years), and cardiovascular disorders (17 years; 95% CI, 12-21 years). CONCLUSION Nearly 1 out of 6 patients undergoing orthognathic surgery has a systemic condition. Knowledge of the prevalence and characteristics of these patients creates awareness among surgeons and a foundation for future studies on perioperative management.
Collapse
Affiliation(s)
- Jonas Ver Berne
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Group Biomedical Sciences, Catholic University Leuven, Leuven, Belgium.; Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium..
| | - Constantinus Politis
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Group Biomedical Sciences, Catholic University Leuven, Leuven, Belgium.; Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Joeri Meyns
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Group Biomedical Sciences, Catholic University Leuven, Leuven, Belgium.; Department of Oral and Maxillofacial Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Jiqing Li
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Group Biomedical Sciences, Catholic University Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Group Biomedical Sciences, Catholic University Leuven, Leuven, Belgium.; Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
10
|
Thepmankorn P, Choi CB, Haimowitz SZ, Parray A, Grube JG, Fang CH, Baredes S, Eloy JA. ASA Physical Status Classification and Complications Following Facial Fracture Repair. Ann Otol Rhinol Laryngol 2021; 131:1252-1260. [PMID: 34918565 DOI: 10.1177/00034894211059599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND To investigate the association between American Society of Anesthesiologists (ASA) physical status classification and rates of postoperative complications in patients undergoing facial fracture repair. METHODS Patients were divided into 2 cohorts based on the ASA classification system: Class I/II and Class III/IV. Chi-square and Fisher's exact tests were used for univariate analyses. Multivariate logistic regressions were used to assess the independent associations of covariates on postoperative complication rates. RESULTS A total of 3575 patients who underwent facial fracture repair with known ASA classification were identified. Class III/IV patients had higher rates of deep surgical site infection (P = .012) as well as bleeding, readmission, reoperation, surgical, medical, and overall postoperative complications (P < .001). Multivariate regression analysis found that Class III/IV was significantly associated with increased length of stay (P < .001) and risk of overall complications (P = .032). Specifically, ASA Class III/IV was associated with increased rates of deep surgical site infection (P = .049), postoperative bleeding (P = .036), and failure to wean off ventilator (P = .027). CONCLUSIONS Higher ASA class is associated with increased length of hospital stay and odds of deep surgical site infection, bleeding, and failure to wean off of ventilator following facial fracture repair. Surgeons should be aware of the increased risk for postoperative complications when performing facial fracture repair in patients with high ASA classification.
Collapse
Affiliation(s)
- Parisorn Thepmankorn
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Chris B Choi
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Sean Z Haimowitz
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Aksha Parray
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Jordon G Grube
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Christina H Fang
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ, USA.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.,Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA.,Department of Otolaryngology and Facial Plastic Surgery, Saint Barnabas Medical Center-RWJBarnabas Health, Livingston, NJ, USA
| |
Collapse
|
11
|
Dasari N, Jiang A, Skochdopole A, Chung J, Reece EM, Vorstenbosch J, Winocour S. Updates in Diabetic Wound Healing, Inflammation, and Scarring. Semin Plast Surg 2021; 35:153-158. [PMID: 34526862 DOI: 10.1055/s-0041-1731460] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Diabetic patients can sustain wounds either as a sequelae of their disease process or postoperatively. Wound healing is a complex process that proceeds through phases of inflammation, proliferation, and remodeling. Diabetes results in several pathological changes that impair almost all of these healing processes. Diabetic wounds are often characterized by excessive inflammation and reduced angiogenesis. Due to these changes, diabetic patients are at a higher risk for postoperative wound healing complications. There is significant evidence in the literature that diabetic patients are at a higher risk for increased wound infections, wound dehiscence, and pathological scarring. Factors such as nutritional status and glycemic control also significantly influence diabetic wound outcomes. There are a variety of treatments available for addressing diabetic wounds.
Collapse
Affiliation(s)
- Nina Dasari
- Division of Plastic Surgery, Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Austin Jiang
- Division of Plastic Surgery, Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Anna Skochdopole
- Division of Plastic Surgery, Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Jayer Chung
- Division of Vascular Surgery, Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Edward M Reece
- Division of Plastic Surgery, Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Joshua Vorstenbosch
- Division of Plastic Surgery, Department of Surgery, McGill University, Montreal, Canada
| | - Sebastian Winocour
- Division of Plastic Surgery, Department of Surgery, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
12
|
Lee CC, Hajibandeh JT, Tannyhill RJ, Peacock ZS. Is Outpatient Management of Mandibular Fractures Associated With Inflammatory Complications? An ACS-NSQIP Study. J Oral Maxillofac Surg 2021; 79:2507-2518. [PMID: 33964241 DOI: 10.1016/j.joms.2021.03.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/19/2021] [Accepted: 03/19/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE 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. METHODS 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. RESULTS 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). CONCLUSIONS 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.
Collapse
Affiliation(s)
- Cameron C Lee
- Resident, Oral & Maxillofacial Surgery, Massachusetts General Hospital and Clinical Fellow, Harvard School of Dental Medicine, Boston, MA
| | - Jeffrey T Hajibandeh
- Instructor, Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA
| | - R John Tannyhill
- Instructor, Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA
| | - Zachary S Peacock
- Assistant Professor, Oral & Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA.
| |
Collapse
|
13
|
Inpatient Versus Outpatient Operative Management of Isolated Facial Fractures. J Craniofac Surg 2021; 32:1338-1340. [PMID: 33770043 DOI: 10.1097/scs.0000000000007387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND 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. METHODS 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. RESULTS We identified 3350 patients who underwent operative fixation of isolated facial fractures. The majority of these cases (70.3%) 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 (6.3% versus 2.3%), reoperation (4.3% versus 1.7%), and readmission (6.9% 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 in the inpatient group persisted [odds ratio (OR) = 1.9, confidence interval (CI) 1.2-3.0, P = 0.01] while the risk of reoperation (OR = 1.7, CI 1.0-2.9, P = 0.08) and risk of readmission (OR = 1.4, CI 0.7-2.6, P = 0.33) no longer showed statistical significance between the inpatient and outpatient groups. CONCLUSIONS Inpatient operative management of isolated facial fractures is associated with an almost 2-fold increased risk of complications, though no increased risk of reoperation or readmission.
Collapse
|
14
|
Chung SY, Govindan A, Babu A, Tassler A. Thyroidectomy Complications in Patients with Diabetes Mellitus. Otolaryngol Head Neck Surg 2019; 161:46-51. [DOI: 10.1177/0194599819835793] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Objective To (1) analyze postoperative thyroidectomy outcomes in patients with diabetes mellitus (DM), who are prone to deleterious effects of glucose dysmetabolism, and (2) apply findings to optimize perioperative management of diabetics requiring thyroid surgery. Study Design Retrospective database analysis. Setting University hospital. Subjects and Methods The National Inpatient Sample was queried using International Classification of Diseases, Ninth Revision, Clinical Modification and Procedure Coding System (PCS) codes for patients with benign or malignant thyroid disease who underwent thyroid surgery between 2002 and 2013. An analysis of demographics, comorbidities, and postoperative outcomes was conducted between a DM vs non-DM cohort using bivariate and multivariate techniques. Results In total, 103,842 cases met inclusion criteria; 14.2% were diabetics. Diabetics had significantly higher rates of baseline comorbid chronic pulmonary disease, hypertension, obesity, and anemia. Following thyroidectomy, patients with DM were more likely to have vocal cord paresis or paralysis compared to non-DM patients (2.0% vs 1.3%; P < .001). However, when adjusting for demographics and comorbidities, there was no significant difference in this complication between the 2 groups. Diabetics had independently higher rates of cardiac, pulmonary, and urinary complications, as well as transfusion, reintubation, and in-hospital mortality. Diabetics had longer hospital stays (2.76 vs 1.97; P < .001) with higher incurred hospital charges (32,921 vs 25,198; P < .001). Conclusion Although DM often confers metabolic and ischemic derangements secondary to hyperglycemia such as neuropathy, this comorbidity was not independently associated with higher rates of vocal cord paresis or paralysis following thyroid surgery. However, DM predicted other adverse outcomes, including greater cardiac, pulmonary, and urinary complications, as well as transfusion, reintubation, and in-hospital mortality.
Collapse
Affiliation(s)
- Sei Y. Chung
- Department of Otolaryngology–Head and Neck Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA
| | - Aparna Govindan
- Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Archana Babu
- Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Andrew Tassler
- Department of Otolaryngology–Head and Neck Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA
| |
Collapse
|
15
|
National Study of Ocular Hospitalizations in Medicare Beneficiaries. Am J Ophthalmol 2019; 199:238-245. [PMID: 30553807 DOI: 10.1016/j.ajo.2018.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 11/30/2018] [Accepted: 12/04/2018] [Indexed: 01/14/2023]
Abstract
PURPOSE To study the characteristics of Medicare beneficiaries hospitalized for ophthalmic conditions. DESIGN Cross-sectional study. METHODS The 2015 National Medicare 100% Inpatient Limited Dataset was analyzed to identify all patients with either an admitting or primary diagnosis for an ophthalmic condition using ICD-9-CM codes. All other hospitalized Medicare patients served for comparison. Comorbidities were calculated using the Elixhauser Comorbidity Index. Multivariable logistic regression was used to determine odds of primary ophthalmic hospitalization after controlling for patient characteristics and medical comorbidities. RESULTS For 2015, there were a total of 13 152 Medicare patients with ocular hospitalizations compared to 6 621 005 patients with nonophthalmic events. Most ophthalmic patients were emergent admissions (73.19%) with routine discharges (75.50%) and low rates of inpatient mortality (0.62%). The top admitting diagnoses for nontraumatic and traumatic eye conditions were diplopia (11.69%) and closed fracture of the orbital floor (3.76%), respectively. Patients admitted for eye conditions were more likely to be younger, to be African American, and to have hypertension, valvular heart disease, diabetes, hypothyroidism, AIDS, lymphoma, solid tumor without metastasis, rheumatologic diseases, alcohol and drug abuse, psychoses, and depression compared to the general Medicare inpatient population. CONCLUSIONS Most inpatient admissions for US Medicare beneficiaries with primary ophthalmic diagnoses were for nontraumatic disorders of the eye and adnexa. Ophthalmic admissions were on average shorter in duration and had lower rates of inpatient mortality compared to nonophthalmic admissions. Patients admitted for eye conditions were more likely to have comorbidities such as hypertension, diabetes, and depression compared to the general Medicare inpatient population.
Collapse
|
16
|
Antibiotic use in facial plastic surgery. Curr Opin Otolaryngol Head Neck Surg 2018; 26:242-247. [PMID: 29750669 DOI: 10.1097/moo.0000000000000464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The aim of this study was to review and discuss recent literature regarding perioperative use of antibiotics in the context of facial plastic surgery. RECENT FINDINGS Despite research efforts, there continues to be insufficient evidence in support of, or against, the use of antimicrobial prophylaxis. SUMMARY Current available evidence regarding antibiotic use in facial plastic surgery procedures fails to demonstrate routine benefit. Therefore, the advantages accompanying administration of preoperative antibiotics should be weighed against any potential complications on a case-by-case basis. Future large-scale prospective studies will be beneficial in developing standardized criteria directing appropriate antibiotic use.
Collapse
|
17
|
Kim J, Shin SH, Kang JK, Kim JW. HX-1171 attenuates pancreatic β-cell apoptosis and hyperglycemia-mediated oxidative stress via Nrf2 activation in streptozotocin-induced diabetic model. Oncotarget 2018; 9:24260-24271. [PMID: 29849938 PMCID: PMC5966269 DOI: 10.18632/oncotarget.24916] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 09/04/2017] [Indexed: 12/20/2022] Open
Abstract
Streptozotocin (STZ) acts specifically on pancreatic beta cells, inducing cell destruction and cell dysfunction, resulting in diabetes. Many studies have reported that nuclear factor-erythroid 2-related factor 2 (Nrf2), a main regulator of antioxidant expression, prevents and improves diabetes-related diseases. In this study, we investigated the antidiabetic effect of the newly discovered Nrf2 activator, HX-1171, in the STZ-induced diabetic mouse model. HX-1171 enhanced insulin secretion by reducing STZ-induced cell apoptosis, and decreased intracellular reactive oxygen species (ROS) generation by upregulating the expression of antioxidant enzymes through Nrf2 activation in INS-1 pancreatic beta cells. In STZ-induced diabetic mice, HX-1171 administration significantly lowered blood glucose levels and restored blood insulin levels. In the STZ-only injected mice, the pancreatic islets showed morphological changes and loss of function, whereas the HX-1171-treated group was similar to that of the control group. These results suggest that HX-1171 may be developed as a promising therapeutic agent for diabetes-related diseases.
Collapse
Affiliation(s)
- Jimin Kim
- Cell Factory Research Center, Division of Systems Biology and Bioengineering, Korea Research Institute of Bioscience and Biotechnology, Daejeon, Republic of Korea.,Department of Functional Genomics, KRIBB School of Bioscience, University of Science and Technology, Daejeon, Republic of Korea
| | - Su-Hyun Shin
- Cell Factory Research Center, Division of Systems Biology and Bioengineering, Korea Research Institute of Bioscience and Biotechnology, Daejeon, Republic of Korea.,Department of Functional Genomics, KRIBB School of Bioscience, University of Science and Technology, Daejeon, Republic of Korea
| | - Jong-Koo Kang
- Department of Laboratory Animal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Jae Wha Kim
- Cell Factory Research Center, Division of Systems Biology and Bioengineering, Korea Research Institute of Bioscience and Biotechnology, Daejeon, Republic of Korea.,Department of Functional Genomics, KRIBB School of Bioscience, University of Science and Technology, Daejeon, Republic of Korea
| |
Collapse
|
18
|
Defining the Association between Diabetes and Plastic Surgery Outcomes: An Analysis of Nearly 40,000 Patients. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1461. [PMID: 28894673 PMCID: PMC5585446 DOI: 10.1097/gox.0000000000001461] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 07/06/2017] [Indexed: 12/17/2022]
Abstract
Background: Diabetes is an increasingly prevalent comorbidity in patients presenting for surgery, impacting nearly 14% of adults in the United States. Although it is known that diabetic patients are at an increased risk for postoperative complications, there is a paucity of literature on the specific ramifications of diabetes on different surgical procedures. Methods: Using the American College of Surgeons National Surgical Quality Improvement Program dataset, demographics, outcomes, and length of in-patient hospitalization were examined for patients who underwent plastic surgery between 2007 and 2012. Adjusted multivariable logistic regression models were used to assess the relationship between diabetes status and a spectrum of medical and surgical postoperative outcomes. Results: Thirty-nine thousand four hundred seventy-five plastic surgery patients were identified, including 1,222 (3.10%) with insulin-dependent diabetes mellitus (IDDM) and 1,915 (4.75%) with non–insulin-dependent diabetes mellitus (NIDDM), who had undergone breast, hand/upper and lower extremity, abdominal, or craniofacial procedures. Logistic regression analyses showed that only insulin-dependent diabetics had a higher likelihood of surgical complications (IDDM: P value < 0.0001; NIDDM: P value < 0.103), whereas patients with both IDDM and NIDDM had increased likelihoods of medical complications (IDDM: P value < 0.001; NIDDM: P value = 0.0093) compared with nondiabetics. Average hospital stay for diabetics was also longer than for nondiabetics. Conclusions: Diabetes is associated with an increase in a multitude of postoperative complications and in hospital length of stay, in patients undergoing plastic surgery. Diabetes status should thus be evaluated and addressed when counseling patients preoperatively. Risks may be further stratified based on IDDM versus NIDDM status.
Collapse
|
19
|
Big data in facial plastic and reconstructive surgery: from large databases to registries. Curr Opin Otolaryngol Head Neck Surg 2017; 25:273-279. [PMID: 28525400 DOI: 10.1097/moo.0000000000000377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW There are many limitations to performing clinical research with high levels of evidence in facial plastic and reconstructive surgery (FPRS), such as randomization into surgical groups and sample size recruitment. Therefore, additional avenues for exploring research should be explored using big data, from databases to registries. Other organizations have developed these tools in the evolving landscape of outcomes measurement and value in healthcare, which may serve as models for our specialty. RECENT FINDINGS Over the last 5 years, FPRS literature of large-scale outcomes research, utilizing several administrative databases, has steadily grown. Our objectives are to describe key administrative databases, strengths and weaknesses of each, and identify recent FPRS publications utilizing big data. A registry with FPRS defined outcomes has the most potential. SUMMARY Although FPRS research has trended to a more evidence-based approach in the modern healthcare era, gaps persist. Several large administrative databases or registries can address voids in outcomes research within FPRS.
Collapse
|