Analysis of pediatric facial fracture repair rates and complications 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: The management of pediatric facial fractures focuses on the prevention of aesthetic deficits and functional sequelae. Changes in the size, shape, and proportions of the craniofacial skeleton during growth represent a significant consideration for physicians treating pediatric patients who present with facial fracture. Currently there is a paucity of data on which pediatric facial fractures should be surgically repaired and when. In this study we used a California state-wide database to determine the prevalence of facial fractures in the pediatric population and examine which fractures are repaired. In addition to the timing of the repair, complications and resource utilization of the healthcare system were analyzed.
Methods: Pediatric patients under the age of 18 were identified using the California Office of Statewide Health Planning and Development (OSHPD) patient discharge database for admissions occurring between January 2015 and December 2018. International Classification of Diseases, Version 10 diagnosis codes were used to classify facial fractures. The associated diagnoses, complications, and number of subsequent repairs patients underwent were analyzed in order to determine the typical course of pediatric facial fractures.
Results: Of the 3,499 patients diagnosed with facial fracture, 23.0% underwent surgical repair (N = 803). The three most commonly repaired fractures were mandible (66.3%), nasal (26.4%), and orbital (19.2%). Most patients presenting with facial fracture were male (69.4%, N = 2,427) with a mean age of 10.7 years. A vast majority of the patients presented to the hospital with urgent/emergency indications (93.3%, N = 3,266). A minority of patients experienced complications from their treatment during the study period (7.9%, N = 275).
Conclusion: Our analysis found that most fractures were managed non-operatively, but those that did receive an operation did so during their index admission. In addition, the most repaired fractures were mandibular, nasal, and orbital fractures. The present study represents one of the largest pediatric samples to have assessed facial fractures, repair rates, and sequelae.
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