Age and Number of Surgeries Increase Risk for Complication in Polytrauma Patients with Operative Maxillofacial Fractures by Ashkaun Shaterian in Crimson Publishers: Surgery Open Access Journal

Crimson Publishers: Surgery Open Access Journal

Purpose: Polytrauma patients often sustain complex head/neck injuries requiring prolonged hospitalizations and multiple operations. Few studies have evaluated the associated injury patterns and risk factors for poor clinical outcomes.

Methods: We evaluated consecutive polytrauma patients with operative maxillofacial fractures treated at a level 1 trauma medical center between 1995-2013. We numerated concomitant head/neck injuries to identify potential injury patterns. Lastly, we performed a multivariate analysis to determine independent risk factors for complications during the acute hospitalization period.

Results: 232 polytrauma patients presented with operative maxillofacial fractures. We found 38.8% of patients had a secondary maxillofacial fracture, 16.4% had intracranial hemorrhage, 23.7% had skull fractures, and 12.1% had spinal fractures. The rate of complication during admission was 28.3%. Multivariate analysis revealed advanced patient age and increased number of operations to predict the rate of complication. Patients requiring more than one operation had a 1.8-fold increase in complication rate (p<0.01) and older patients had a 4.5% increase in complication rate (p<0.05) for every year of increased age.

Conclusion: Polytrauma patients have a high incidence of secondary maxillofacial fractures, concomitant head/neck injury, and inpatient complication rate. Knowledge of associated injury patterns can help increase awareness and guide physician decision-making to avoid missed/delayed injuries. Delaying non-urgent operative intervention after the initial hospitalization period as well providing more conservative management for older patients may decrease complication rates and improve outcomes.

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