Mire D, Chapple AG, Christensen BJ. Does Preoperative Surgical Delay Lead to Increased Postsurgical Length of Stay or Reoperation in Patients With Severe Odontogenic Infections?
J Oral Maxillofac Surg 2023;
81:1161-1169. [PMID:
37348841 DOI:
10.1016/j.joms.2023.06.003]
[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: 03/09/2023] [Revised: 05/31/2023] [Accepted: 06/07/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND
While severe odontogenic infections can be life-threatening and emergent surgery can be required more often, surgical management in the operating room (OR) is completed as soon as feasible. However, provider schedules and OR availability can occasionally lead to longer delays before surgery, but their effect on outcomes is unknown.
PURPOSE
The purpose of this study was to determine the association of preoperative surgical delay with postsurgical length of stay (LOS) and reoperation in patients with severe odontogenic infections.
STUDY DESIGN, SETTING, SAMPLE
The authors conducted a retrospective cohort study consisting of all adult patients treated in the OR with incision and drainage for odontogenic infections from 1/1/2015 to 7/30/2021 at a large, urban academic hospital.
PREDICTOR VARIABLE
The primary predictor variable was the length of presurgical delay-the number of hours between arrival in the emergency department and the start of surgery.
MAIN OUTCOME VARIABLES
The primary outcome variable was the postsurgical LOS and the secondary outcome variable was the rate of reoperation.
COVARIATES
Demographics, medical history, exam findings, diagnosis, and treatment-related variables were also analyzed.
ANALYSES
Descriptive and bivariate analyses were performed along with multivariable linear and logistic regression. A P value of < .05 was considered significant.
RESULTS
There were 401 patients included in the study with 50.9% men and a mean age of 39.1 years. Increased length of presurgical delay (hours) was associated with a decreased postsurgical LOS (β = -0.05 days, P = .01) and length of presurgical delay was not associated with reoperation (P = .51) in the unadjusted analyses. However, length of presurgical delay was not found to be associated with either LOS (β = -0.02, 95% confidence interval (CI) -0.05 to 0.01, P = .12) or reoperation (adjusted odds ratio (aOR) 1.0, 95% CI 0.96 to 1.02, P = .67) in the adjusted analyses.
CONCLUSIONS AND RELEVANCE
The association of decreased length of presurgical delay with increased postsurgical LOS in the unadjusted analysis could reflect the practice of rapid intervention for the most ill patients. After adjusting for number of spaces, a primary indicator of infection severity, length of presurgical delay was not associated with either LOS or return to the operating room.
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