Does the Geographical Distribution of Facial Trauma Surgeons Correspond to Facial Trauma Burden? A Nationwide Population-Level Analysis

Abstract

It is unknown if craniofacial trauma services are inequitably distributed throughout the US. The authors aimed to describe the geographical distribution of craniofacial trauma, surgeons, and training positions nationwide. State-level data were obtained on craniofacial trauma admissions, surgeons, training positions, population, and income for 2016 to 2017. Normalized densities (per million population [PMP]) were ascertained. State/ regional-level densities were compared between highest/lowest. Risk-adjusted generalized linear models were used to determine independent associations. There were 790,415 craniofacial trauma admissions (x? ¼ 2330.6 PMP), 28,004 surgeons (x? ¼ 83.5 PMP), and 746 training positions (x? ¼ 1.9 PMP) nationwide. There was significant state-level variation in the density PMP of trauma (median 1999.5 versus 2983.5, P < 0.01), surgeon (70.8 versus 98.8, P < 0.01), training positions (0 versus 3.4, P < 0.01) between lowest/highest quartiles. Surgeon distribution was positively associated with income and training positions density (P < 0.01). Subanalysis revealed that there was an increase of 6.7 plastic and reconstructive surgeons/PMP for every increase of 1000 trauma admissions/PMP (P < 0.01). There is an uneven state-level distribution of facial trauma surgeons across the US associated with income. Plastic surgeon distribution corresponded closer to craniofacial trauma care need than that of ENT and OMF surgeons. Further work to close the gap between workforce availability and clinical need is necessary.

Ambulatory Orbital Fracture Repair: An Analysis of ER Visits After Surgery From a Multistate Study

“…Several large database studies have found that there was a greater incidence of orbital fractures in the south compared to other geographic regions but no significant difference in the rates of operation 1,24 . There were also regional differences in the density of facial trauma surgeons with fewer facial trauma surgeons in the south compared to the west by population density 25 . This can impact the timely receipt of postoperative care with more reliance on ER visits rather than office visits to address symptoms in locations with fewer surgeons.…”

“…1,24 There were also regional differences in the density of facial trauma surgeons with fewer facial trauma surgeons in the south compared to the west by population density. 25 This can impact the timely receipt of postoperative care with more reliance on ER visits rather than office visits to address symptoms in locations with fewer surgeons. A multitude of other factors, including the severity of the injury, patterns of facial fracture, and public safety laws may contribute to these regional differences and warrant further investigation.…”