Analysis of readmission and complications after repair of orbital fractures using California's Office of Statewide Health Planning and Development (OSHPD) database
Daniel Neubauer1, Richard Calvo2, Rachel Segal1, Michael Hornacek1, Matthew Martin2, Samuel Lance1, Christopher Reid1, Amanda Gosman1 1University of California San Diego, San Diego, CA 2Scripps Mercy Hospital, San Diego, CA
Background: Orbital fractures represent one the most common trauma-related facial fracture. The surgical treatment of orbital fractures is managed by plastic surgeons, otolaryngologists, ophthalmologists, and oral and maxillofacial surgeons. Orbital fractures can present with many concomitant injuries including involvement of the extraocular muscles and blowout of the orbital floor. Many factors including age of the patient, associated diagnoses, and complications of the fracture are important for determination of surgical candidacy. We used a state-wide database to determine the prevalence of orbital fractures, rates of surgical repair, and patient outcomes. In addition, the associated morbidity and burden on the healthcare system are presented.
Methods: A longitudinal analysis of patients diagnosed with orbital fracture was performed using the California's Office of Statewide Health Planning and Development (OSHPD) patient discharge database for admissions occurring between January 2015 and December 2018. Patients were identified using International Classification of Diseases version 10 codes. The primary risk factor of interest was surgical management of orbital fractures, and categorized as no repair, repair at the index admission, or delayed repair at a subsequent admission. The primary outcomes of interest were readmission requiring surgical management of the orbital fracture and complications of the fracture. Survival models were developed to evaluate the risk for a repair at readmission adjusting for relevant covariates.
Results: Of the 24,640 patients diagnosed with orbital fracture, 4863 (19.7%) underwent surgical repair. Patients were primarily male (74.9%, N = 18,444) and presented to the hospital in an emergent or unscheduled admission (93.6%, N = 23,056). Approximately 10.6% of patients (N = 2,607) experienced complications which were most associated with fractures of the orbital floor, maxilla, and zygoma. Rates of complications were equivocal in those who had repairs at their index admission versus delayed, except for zygomatic fractures which had a higher rate of complications in delayed versus immediate repair (21.3% vs 15.2%). Multivariable survival analysis found that repair at the index admission (HR 1.40, 95% CI 1.11 – 1.75) and complications (HR 1.62, 95% CI 1.24 – 2.13) were independently associated with an increased risk for readmission requiring additional surgical repair.
Conclusion: Although most orbital fractures were managed non-operatively, there remains a significant risk for complications that may result in lifelong disability or blindness if not managed correctly. Our analysis found that rates of repair for orbital floor, maxillary, and zygomatic fractures were greater than for other facial fractures. In addition, early operative intervention was associated with equivocal complication rates compared to delayed, except with zygomatic fractures which had higher complications in their delayed repair group.
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