Can Frailty Indices Predict Surgical Risk in Open Reduction and Fixation of Facial Fractures?

Abstract

Purpose: The present study sought to evaluate whether the mFI-5 and modified Charlson Comorbidity Index (mCCI) are stronger predictors of 30-day postoperative complications after open reduction of facial fractures compared with historic risk proxies. Methods: A retrospective review of the American College of Surgeons’ National Surgical Quality Improvement Program (ACS-NSQIP) database was conducted to investigate patients who underwent open reduction facial fracture surgery between 2013 and 2018. Risk factors including age, smoking status, body mass index (BMI), comorbidities, and American Society of Anesthesiologists (ASA) class were extracted for each patient. The mFI-5 score and mCCI score were calculated based on this data. Univariate logistic regressions were performed (P<0.05) Results: A total of 2667 cases were included. Of these, 2131 (80%) were male. The strongest predictors for overall 30-day complications and complication severity were ASA class ≥3 (Odds Ratio [OR]=3.34), comorbidities ≥2 (OR=2.78), mCCl score ≥2 (OR=2.19), and mFI-5 ≥1 (OR=1.96). Smoking status and BMI were not strong predictors of total complications or complication severity. Age was found to be a statically significant, but low-impact, predictor of complications, and severity (OR=1.02, P<0.001). The only significant predictors of surgical site infections (SSI) were smoking status (OR=1.56) and ASA class ≥3 (OR=2.40). mFI-5 ≥1 was a significant predictor of hospital readmission. BMI was not associated with any increased risk. Conclusions: The mCCI and mFI-5 are statistically significant predictors of total complications and complication severity in open reduction of facial fracture repair, and thus provide a tool to inform decision making and improve care. Smoking status may increase risk for SSIs following facial fracture repair.

Comparative Analysis of Open and Closed Nasal Fractures in Trauma Settings: Mechanisms, Intent, Surgical Interventions, and Outcomes

“…These ndings suggest that open nasal fractures are often associated with more severe overall traumas. The data also showed a slightly higher percentage of patients with open nasal fractures arriving without signs of life and a marginally lower rate of inter-facility transfers, highlighting the urgent and critical nature of open nasal fracture cases in trauma settings [15][16]. These differences underscore the need for increased clinical vigilance and prompt, comprehensive management of patients presenting with open nasal fractures.…”

Early Outcomes and Risk Factors in Orthognathic Surgery for Mandibular and Maxillary Hypo- and Hyperplasia: A 13-Year Analysis of a Multi-Institutional Database

“…The National Surgical Quality Improvement Program of the American College of Surgeons (NSQIP) collects validated data from more than 700 US hospitals, resulting in a large and diverse patient collection. Specifically, in the field of oral and maxillofacial surgery, the current literature includes numerous studies evaluating the NSQIP data [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ]. Accordingly, analyses of the NSQIP records can provide valuable and insightful information that facial surgeons may wish to implement into their perioperative workflow.…”