SA3 - What Factors are Associated With Hospital Admission of Emergency Department Patients With Mandible Fractures?

Abstract:

Background: There is no consensus on optimal timing of mandibular fracture repair.[1] Triaging emergency department (ED) patients presenting with mandibular fractures can therefore be ambiguous. Recent studies have found similar rates of post-operative inflammatory complications between mandibular fractures repaired in the outpatient versus inpatient setting.[2] It is unclear nationally which patients with isolated mandible fractures are admitted to the hospital from the ED, and which factors are associated with admission. The purpose of this study was to generate nationally representative estimates of the incidence and predictors of hospital admission for patients with isolated mandible fractures.

Methods: This retrospective cohort study used the 2018 Nationwide Emergency Department Sample (NEDS), the largest nationally representative all-payer emergency department database in the United States, to identify patients with isolated mandible fractures. The primary predictor variable was primary payer (public, private, self-pay, other/no-charge). The primary outcome variable was hospital admission. Covariates included patient, injury, and hospital-related variables. Descriptive, bivariate, and multivariate logistic regression statistics were utilized to produce national estimates and identify independent predictors of hospital admission.

Results: A total of 27,238 patient encounters involving isolated mandible fractures were included. Within the cohort, 5,345 encounters (20%) resulted in hospital admission. In terms of primary payer, 46% had public insurance, 25% had private insurance, 22% had self-pay, and 7% had no charge. In bivariate analyses, patients with public insurance were more likely to be admitted (p=0.006, OR = 1.3, 95% CI = 1.08-1.58). In the multivariable model, patient insurance was not associated with hospital admission (P =0.77). Instead, independent predictors of admission included: higher Charlson Comorbidity Index (OR = 1.32, 95% CI = 1.18 – 1.48), alcohol use disorder (OR = 3.47, 95% CI = 2.74 – 4.39), substance use disorder (OR = 1.43, 95% CI = 1.20 – 1.71), greater number of mandible fractures (OR = 3.08, 95% CI = 2.64 – 3.59), level I trauma center (OR = 4.06, 95% CI = 2.38 – 6.93), level II trauma center (OR = 3.18, 95% CI =1.86 – 5.44), and level III trauma center (OR 1.6, 95% CI = 0.79 – 3.26).

Conclusions: In 2018, 20% of ED encounters in the United States involving patients with isolated mandible fractures resulted in hospital admission. Several patient and hospital characteristics were associated with greater likelihood of hospital admission. Notably, patient insurance status was not associated with hospital admission. These results suggest that a majority of isolated mandible fractures are currently managed on an outpatient basis.
 

References:
1. Hurrell MJL, Batstone MD: The effect of treatment timing on the management of facial fractures: a systematic review. International Journal of Oral and Maxillofacial Surgery 43: 944, 2014.
2. 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 79: 2507, 2021.