(59) Influence of the COVID-19 Pandemic on Geriatric Maxillofacial Trauma

Abstract: The New York metropolitan area was significantly disrupted by the COVID-19 pandemic. Governmental policies such as social distancing and the restriction of mass travel certainly upset community norms, but it is unclear how influential these practices were on health systems. While elective surgeries were largely postponed, acute trauma services were maintained. Little is known if patterns of maxillofacial trauma were altered because of infection control strategies and their consequential changes to everyday life. This study sought to investigate the influence of the COVID-19 pandemic and its associated social measures on the patterns of maxillofacial trauma in the geriatric population within Northwell Health hospitals.

This retrospective study compared demographics and trends in maxillofacial trauma of patients aged 65-95 years during the peri-pandemic period. The pre-pandemic period was defined as September 13th, 2018 to March 12th, 2020 and the intra-pandemic period as March 13th, 2020 to September 13th, 2021. Data was acquired through cataloged admission and discharge information within the Northwell Health Trauma Institute database. Patient demographics, location and etiology of injury, facture management, hospital courses, disposition, and outcomes were compared via independent samples t-tests and ANOVA analyses.

348 individuals sustained maxillofacial fractures in the pre-pandemic period, as opposed to 336 individuals who sustained similar injuries in the intra-pandemic period – an overall decrease of 3.57% (p < 0.03). There was no statistical difference in distribution of fractures by age between groups. An increased proportion of Hispanic geriatric patients presented with maxillofacial fractures during the pandemic (+1.90%, p< 0.03). Falls remained the most common etiology of injury. Injuries were significantly more likely to occur within the home during the pandemic (p < 0.03). There was a significant reduction in the proportion of maxillofacial fractures sustained in motor vehicle accidents (-4.44%, p< 0.03). Alcohol use often coincided maxillofacial trauma (38.62% pre- vs. 39.10% intra-pandemic). Patients were often transferred to larger trauma centers during the pandemic but were significantly less likely to undergo operative management (8.33% pre- vs. 3.87% intra-pandemic, p< 0.03). Discharges to home were significantly more common during the intra-pandemic period (p < 0.03). Overall mortality rate increased from 2.30% to 4.76% (p < 0.03).

The epidemiology and management of geriatric maxillofacial trauma saw considerable shifts during the COVID-19 pandemic. An overall decrease in maxillofacial trauma within the geriatric population was demonstrated. Trauma secondary to falls increased, with a simultaneous reduction in injuries caused by motor vehicle accidents. This may be a consequence of social distancing and work-from-home policies decreasing overall traffic and public congestion. An increase in injuries seen within the home during the pandemic is also coincident with these suggestions. Operative management was less frequent, with centers often taking more conservative or outpatient approaches to care. Whether this resulted from less severe in-home injuries or conscious efforts by the healthcare system to minimize provider exposure to SARS-CoV2 remains unclear. Racial/ethnic healthcare disparities were evident during the pandemic, particularly in the Hispanic population. Early recognition of these differences will allow for advanced resource planning and implementation of more efficient practice strategies should a comparable pandemic occur in the future.

Infante-Cossio P, Fernandez-Mayoralas-Gomez M, Gonzalez-Perez LM, Martinez-de-Fuentes R, Rollon-Mayordomo A, Torres-Carranza E. Impact of the coronavirus pandemic on maxillofacial trauma: A retrospective study in southern Spain. Med Oral Patol Oral Cir Bucal. 2022 May 1;27(3):e223-e229.

Philip G, Dominic S, Poorna T A, Ek J. Pattern of maxillofacial fractures in a Tertiary Referral Centre in Central Kerala - A comparison between the Pre-COVID and COVID periods. J Oral Biol Craniofac Res. 2022 Jan-Feb;12(1):45-48.

Stanisce L, Fisher AH, Choi BY, Newman A, Wang JL, Koshkareva Y. How Did the COVID-19 Pandemic Affect Trends in Facial Trauma? Craniomaxillofac Trauma Reconstr. 2022 Jun;15(2):132-138.