1
|
Weitzman RE, Subramanian T, Zhao K, Shomorony A, Sclafani AP. Trends in Management and Cost Burden of Facial Fractures: A 14-Year Analysis. Laryngoscope 2024; 134:3120-3126. [PMID: 38294281 DOI: 10.1002/lary.31299] [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: 04/26/2023] [Revised: 10/31/2023] [Accepted: 01/03/2024] [Indexed: 02/01/2024]
Abstract
OBJECTIVE To discuss patient demographics and management and better understand the economic impact associated with the treatment of facial fractures at a major metropolitan level 1 trauma center. STUDY DESIGN Retrospective chart review. METHODS We identified 5088 facial fractures in 2479 patients who presented from 2008 to 2022. Patient demographics, mechanism of injury, associated injuries, treatment information, and hospital charges were collected and analyzed to determine factors associated with surgical management and increased cost burden. RESULTS Our 14-year experience identified 1628 males and 851 females with a mean age of 45.7 years. Orbital fractures were most common (41.2%), followed by maxilla fractures (20.8%). The most common mechanism was fall (43.0%). Surgical management was recommended for 41% of patients. The odds of surgical management was significantly lower in female patients, patients age 65 and older, and patients who presented after the onset of the COVID-19 pandemic. The odds of surgical management was significantly higher for patients who had a mandible fracture or greater than 1 fracture. The average cost of management was highest for naso-orbito-ethmoidal fractures ($37,997.74 ± 52,850.88), followed by LeFort and frontal fractures ($29.814.41 ± 42,155.73 and $27,613.44 ± 39.178.53, respectively). The highest contributor to the total average cost of management was intensive care unit-related costs for every fracture type, except for mandible fractures for which the highest contributor was operating room (OR)-related costs. CONCLUSIONS This study represents one of the largest comprehensive databases of facial fractures and one of the first to provide a descriptive cost analysis of facial trauma management. LEVEL OF EVIDENCE 4 Laryngoscope, 134:3120-3126, 2024.
Collapse
Affiliation(s)
- Rachel E Weitzman
- Department of Otolaryngology Head and Neck Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, U.S.A
| | - Tejas Subramanian
- Department of Otolaryngology Head and Neck Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, U.S.A
| | - Karena Zhao
- Department of Otolaryngology Head and Neck Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, U.S.A
| | - Andre Shomorony
- Department of Otolaryngology Head and Neck Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, U.S.A
| | - Anthony P Sclafani
- Department of Otolaryngology Head and Neck Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, U.S.A
| |
Collapse
|
2
|
Tatsumi H, Matsuda Y, Okui T, Karino M, Koike T, Okuma S, Toda E, Ishizuka S, Sonoyama-Osako R, Morioka R, Kotani T, Shimamura Y, Kanno T. Impact of COVID-19 pandemic on the dynamic of patients with oral and maxillofacial trauma: interrupted time-series analysis. Sci Rep 2024; 14:13202. [PMID: 38851787 PMCID: PMC11162448 DOI: 10.1038/s41598-024-63890-3] [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: 02/08/2024] [Accepted: 06/03/2024] [Indexed: 06/10/2024] Open
Abstract
Oral and maxillofacial trauma is influenced by various factors, including regional characteristics and social background. Due to the coronavirus disease 2019 (COVID-19) pandemic, a state of emergency was declared in Japan in March 2020. In this study, we aimed to examine the dynamics of patients with oral and maxillofacial trauma over a 12-years period using interrupted time-series (ITS) analysis. Patients were examined at the Shimane University Hospital, Maxillofacial Trauma Center from April 2012 to April 2023. In addition to general patient characteristics, data regarding the type of trauma and its treatment were obtained from 1203 patients (770 men and 433 women). Group comparisons showed significant differences in age, trauma status, method of treatment, referral source, route, and injury occasion. ITS analysis indicated significant changes in combined nasal fractures, non-invasive reduction, and sports injuries (P < 0.05), suggesting COVID-19 significantly impacted oral and maxillofacial trauma dynamics. A pandemic of an infectious disease may decrease the number of minor trauma cases but increase the number of injuries from outdoor activities, resulting in no overall change in the dynamics of the number of trauma patients. Medical systems for oral and maxillofacial trauma should be in place at all times, independent of infectious disease pandemics.
Collapse
Affiliation(s)
- Hiroto Tatsumi
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
- Maxillofacial Trauma Center, Shimane University Hospital, Izumo, Shimane, Japan
| | - Yuhei Matsuda
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
| | - Tatsuo Okui
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
- Maxillofacial Trauma Center, Shimane University Hospital, Izumo, Shimane, Japan
| | - Masaaki Karino
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
- Department of Oral and Maxillofacial Surgery, Shimane Prefectural Central Hospital, Izumo, Shimane, Japan
| | - Takashi Koike
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
- Department of Oral and Maxillofacial Surgery, Unnan City Hospital, Unnan, Shimane, Japan
| | - Satoe Okuma
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
- Maxillofacial Trauma Center, Shimane University Hospital, Izumo, Shimane, Japan
| | - Erina Toda
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
- Department of Oral and Maxillofacial Surgery, National Hospital Organization Hamada Medical Center, Hamada, Shimane, Japan
| | - Shinji Ishizuka
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
- Division of Oral and Maxillofacial Surgery, Oki Hospital, Oki, Shimane, Japan
| | - Rie Sonoyama-Osako
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
- Maxillofacial Trauma Center, Shimane University Hospital, Izumo, Shimane, Japan
| | - Reon Morioka
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
- Department of Oral and Maxillofacial Surgery, Masuda Red Cross Hospital, Masuda, Shimane, Japan
| | - Tatsuhito Kotani
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
- Maxillofacial Trauma Center, Shimane University Hospital, Izumo, Shimane, Japan
| | - Yukiho Shimamura
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
- Maxillofacial Trauma Center, Shimane University Hospital, Izumo, Shimane, Japan
| | - Takahiro Kanno
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan.
- Maxillofacial Trauma Center, Shimane University Hospital, Izumo, Shimane, Japan.
| |
Collapse
|
3
|
Petrocelli M, Ruggiero F, Allegri D, Cutrupi S, Baietti AM, Salzano G, Maglitto F, Manfuso A, Copelli C, Barca I, Cristofaro MG, Galvano F, Loche VP, Gemini P, Tewfik K, Burlini D, Bernardi M, Bianchi FA, Catanzaro S, Ascani G, Consorti G, Balercia P, Braconi A, Scozzaro C, Catalfamo L, De Rinaldis D, De Ponte FS, Tarabbia F, Biglioli F, Giovacchini F, Tullio A, Cama A, Di Emidio P, Ferrari S, Perlangeli G, Rossi MB, Biglio A, De Riu G, Califano L, Vaira LA. Changes in hospital admissions for facial fractures during and after COVID 19 pandemic: national multicentric epidemiological analysis on 2938 patients. Oral Maxillofac Surg 2024; 28:753-759. [PMID: 38093155 DOI: 10.1007/s10006-023-01201-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 12/07/2023] [Indexed: 06/04/2024]
Abstract
PURPOSE The objective of this multicenter study was to examine the differences in maxillo-facial fractures epidemiology across the various phases of the SARS-CoV-2 pandemic. METHODS This is a retrospective study on patients who underwent surgery for facial bone fractures in 18 maxillo-facial surgery departments in Italy, spanning from June 23, 2019, to February 23, 2022. Based on the admission date, the data were classified into four chronological periods reflecting distinct periods of restrictions in Italy: pre-pandemic, first wave, partial restrictions, and post-pandemic. Epidemiological differences across the groups were analysed. RESULTS The study included 2938 patients. A statistically significant difference in hospitalization causes was detected between the pre-pandemic and first wave groups (p = 0.005) and between the pre-pandemic and partial restriction groups (p = 0.002). The differences between the pre- and post-pandemic groups were instead not significant (p = 0.106). Compared to the pre-pandemic period, the number of patients of African origin was significantly higher during the first wave and the post-pandemic period. No statistically significant differences were found across the periods concerning gender, age, fracture type, treatment approach, and hospital stay duration CONCLUSIONS: The COVID-19 pandemic brought about significant changes in fracture epidemiology, influenced by the restrictive measures enforced by the government in Italy. Upon the pandemic's conclusion, the fracture epidemiology returned to the patterns observed in the pre-pandemic period.
Collapse
Affiliation(s)
- Marzia Petrocelli
- Oral and Maxillo-Facial Unit AUSL Bologna Bellaria-Maggiore Hospital, Bologna, Italy
| | - Federica Ruggiero
- Oral and Maxillo-Facial Unit AUSL Bologna Bellaria-Maggiore Hospital, Bologna, Italy
| | - Davide Allegri
- Department of Clinical Governance and Quality, AUSL Bologna Bellaria-Maggiore Hospital, Bologna, Italy
| | | | - Anna Maria Baietti
- Oral and Maxillo-Facial Unit AUSL Bologna Bellaria-Maggiore Hospital, Bologna, Italy
| | - Giovanni Salzano
- Maxillo-facial Surgery Unit, University Hospital of Naples "Federico II,", Naples, Italy
| | - Fabio Maglitto
- Maxillo-Facial Surgery Unit, University of Bari "Aldo Moro,", Bari, Italy
| | - Alfonso Manfuso
- Maxillo-Facial Surgery Unit, University of Bari "Aldo Moro,", Bari, Italy
| | - Chiara Copelli
- Maxillo-Facial Surgery Unit, University of Bari "Aldo Moro,", Bari, Italy
| | - Ida Barca
- Department of Experimental and Clinical Medicine, Unit of Maxillofacial Surgery, Magna Graecia University, Catanzaro, Italy
| | - Maria Giulia Cristofaro
- Department of Experimental and Clinical Medicine, Unit of Maxillofacial Surgery, Magna Graecia University, Catanzaro, Italy
| | - Francesca Galvano
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Paolo Gemini
- Maxillofacial Surgery Unit, ARNAS Brotzu, Cagliari, Italy
| | - Karim Tewfik
- Pediatric Maxillo-Facial Surgery Unit, Children's Hospital of Brescia - ASST Spedali Civili, Brescia, Italy
| | - Dante Burlini
- Pediatric Maxillo-Facial Surgery Unit, Children's Hospital of Brescia - ASST Spedali Civili, Brescia, Italy
| | - Marco Bernardi
- Maxillo-Facial Surgery Unit, ASO Santa Croce e Carle, Cuneo, Italy
| | | | - Susanna Catanzaro
- Department of Maxillo-Facial Surgery, Spirito Santo Hospital, Pescara, Italy
| | - Giuliano Ascani
- Department of Maxillo-Facial Surgery, Spirito Santo Hospital, Pescara, Italy
| | - Giuseppe Consorti
- Maxillo-Facial Surgery Unit, Marche University Hospital, Ancona, Italy
| | - Paolo Balercia
- Maxillo-Facial Surgery Unit, Marche University Hospital, Ancona, Italy
| | - Andrea Braconi
- Maxillo-Facial Surgery Unit, A.R.N.A.S. Civico di Cristina Bonfratelli Hospital, Palermo, Italy
| | - Calogero Scozzaro
- Maxillo-Facial Surgery Unit, A.R.N.A.S. Civico di Cristina Bonfratelli Hospital, Palermo, Italy
| | - Luciano Catalfamo
- UOC of Maxillofacial Surgery, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Danilo De Rinaldis
- UOC of Maxillofacial Surgery, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Francesco Saverio De Ponte
- UOC of Maxillofacial Surgery, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Filippo Tarabbia
- Head and Neck Department, Operative Unit of Maxillo-Facial Surgery, San Paolo Hospital of Milan, Milan, Italy
| | - Federico Biglioli
- Head and Neck Department, Operative Unit of Maxillo-Facial Surgery, San Paolo Hospital of Milan, Milan, Italy
| | | | - Antonio Tullio
- Maxillo-Facial Surgery Unit, Perugia Hospital, Perugia, Italy
| | - Antonia Cama
- Oral and Maxillo-Facial Unit, ASL Teramo - G. Mazzini Hospital, Teramo, Italy
| | - Paolo Di Emidio
- Oral and Maxillo-Facial Unit, ASL Teramo - G. Mazzini Hospital, Teramo, Italy
| | - Silvano Ferrari
- Head and Neck Department, University Hospital of Parma, Parma, Italy
| | | | - Maria Beatrice Rossi
- Maxillo-Facial Surgery, Surgical Sciences Department, University of Turin, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Andrea Biglio
- Head and Neck Department, Operative Unit of Maxillo-Facial Surgery, San Paolo Hospital of Milan, Milan, Italy
- Maxillofacial Surgery Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale San Pietro 43B, 07100, Sassari, Italy
| | - Giacomo De Riu
- Maxillofacial Surgery Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale San Pietro 43B, 07100, Sassari, Italy
| | - Luigi Califano
- Maxillo-facial Surgery Unit, University Hospital of Naples "Federico II,", Naples, Italy
| | - Luigi Angelo Vaira
- Maxillofacial Surgery Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale San Pietro 43B, 07100, Sassari, Italy.
- Biomedical Science Department, PhD School of Biomedical Science, University of Sassari, Sassari, Italy.
| |
Collapse
|
4
|
Dudde F, Schuck O, Schunk J, Filip B. Influence of COVID-19 pandemic on mandible fracture patterns in a German cranio-maxillofacial trauma center: PreCOVID (2019) versus IntraCOVID (2020). Dent Traumatol 2024. [PMID: 38572818 DOI: 10.1111/edt.12949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 02/27/2024] [Accepted: 03/05/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND/AIMS The COVID-19 (Coronavirus Disease-2019) pandemic confronted the global healthcare system with a variety of challenges. The pandemic and the associated lockdowns also had an impact on multiple medical disciplines (i.e. delay of surgery, change of hospital admissions). The aim of this study was to analyze the impact of the COVID-19 pandemic on mandible fracture patterns/distributions and circumstances in a German cranio-maxillofacial trauma center. MATERIALS AND METHODS This retrospective study compared the mandible fracture patterns of patients in the PreCOVID (PC) era (February 2019-January 2020) with patients in the IntraCOVID (IC) era (February 2020-January 2021). In addition to baseline characteristics, the number/type of mandible fractures, location of the mandible fracture, circumstances leading to mandible fracture, and hospital admissions/treatments were analyzed. RESULTS A total of 127 patients was included in this study. In the IC period, the absolute frequencies of mandible fractures decreased (PC = 72 vs. IC = 55). There were minor changes in the mandible fracture locations. An increase of concomitant facial soft tissue injuries (IC = 69.1% vs. PC = 58.3%), as well as higher rates of traumatic tooth loss (IC = 32.7% vs. PC = 22.2%), was observed. Regarding the causes/accidents leading to mandible fractures, there were significant increases in falls and significant decreases in sports accidents as well as interpersonal violence during the IC period. A significant increase in accidents at home and domestic violence during the COVID-19 pandemic, with a simultaneous decrease in weekend and night-time trauma leading to mandible fractures was observed. Furthermore, a significant increase in days from trauma to surgery was recorded. CONCLUSION The COVID-19 pandemic had a significant impact on mandibular fracture patterns. The locations and types of mandibular fractures changed slightly. However, significant differences in the circumstances leading to mandible fractures (increased falls, decreased interpersonal violence) were recorded.
Collapse
Affiliation(s)
- Florian Dudde
- Department of Oral and Maxillofacial Surgery, Army Hospital Hamburg, Hamburg, Germany
| | - Oliver Schuck
- Department of Oral and Maxillofacial Surgery, Army Hospital Hamburg, Hamburg, Germany
| | - Johannes Schunk
- Department of Oral and Maxillofacial Surgery, Army Hospital Hamburg, Hamburg, Germany
| | - Barbarewicz Filip
- Department of Oral and Maxillofacial Surgery, Army Hospital Hamburg, Hamburg, Germany
| |
Collapse
|