CLINICAL QUESTION
What has been the economic impact associated with the treatment of facial fractures at a major metropolitan level 1 trauma center?
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July 2024BOTTOM LINE
The findings of this study, which represents one of the largest comprehensive databases of facial fractures, can inform management and cost trends at other U.S. metropolitan hospitals.
BACKGROUND: Morbidity costs of facial trauma exceed $1 billion each year. With a wide variety of treatment options available and many subspecialties trained in facial trauma treatment, there can be variations in management approach and associated costs. Few studies have compared the economic outcomes of different treatment strategies for facial trauma.
STUDY DESIGN: Retrospective chart review.
SETTING: Department of Otolaryngology-Head and Neck Surgery, New York–Presbyterian Hospital/Weill Cornell Medical Center, New York, N.Y.
SYNOPSIS: Researchers identified 5,088 facial fractures in 2,479 patients (65.7% male; mean age 45.7 years) presenting to a single level 1 trauma center in a major academic hospital from 2008 to 2021. Data was collected and analyzed. The most common type of fracture was orbital (41.2%), followed by maxilla, mandible, zygoma, frontal, LeFort, and naso-orbito-ethmoid (NOE). The most common mechanism of injury was daily living-related falls (43.4%), with assault, traffic-related injuries, and sporting injuries accounting for 25.7%, 13.2%, and 12.8% of cases, respectively. Surgery was recommended in 41.1% of patients. Most mandible and LeFort fractures were managed surgically; most other fracture types were observed. The odds of surgical management were significantly lower in female patients and patients >60 years of age. The average cost of management was highest for NOE fractures ($37,997), followed by LeFort and frontal fractures ($29,814 and $27,613, respectively). The highest cost contributor was intensive care unit-related items for every fracture type except mandible, for which the highest contributor was operating room costs. Authors note that prior literature focused on high-energy injuries, making it difficult to generalize to urban areas with low-energy injuries. Study limitations include its retrospective nature.
CITATION: Weitzman RE, Subramanian T, Zhao K, et al. Trends in management and cost burden of facial fractures: a 14-year analysis [published online ahead of print January 31, 2024]. Laryngoscope: doi.org/10.1002/lary.31299.