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Revealing The True Morbidity Of Facial Fracture Repair: A National Big-data Analysis Of 4,805 Cases Across 15 Years
Georgios Karamitros, M.D.1, Armin Catic, M.D.
2, Izabela Galdyn, M.D.
1, Michael Golinko, M.D.
1, Matthew E. Pontell, M.D.
1, Stephane Braun, M.D.
1, William C. Lineaweaver, M.D.
1, Galen Perdikis, M.D.
1, Judy Pan, M.D.
3, Gregory A. Lamaris, M.D., Ph.D.
3.
1Vanderbilt University, Nashville, TN, USA,
2Center for Big Data Research in Health, University of New South Wales, Sydney, Australia,
3University of Maryland, Baltimore, MD, USA.
PURPOSE: National data on early morbidity after facial fracture repair are limited, and trends amid rising case complexity remain unclear.
METHODS: Using ACS-NSQIP (2007-2022), we identified 4,805 adults undergoing operative repair of mandibular, ZMC, orbital, LeFort, or multiple fractures by plastic or otolaryngologic surgeons. Thirty-day outcomes included superficial, deep, and organ-space surgical site infections (SSIs), wound dehiscence, and return to the OR. Multivariable logistic regression evaluated independent predictors and temporal trends.
RESULTS: The 30-day complication rate was 21.8%, driven by deep SSI (17.0%). Mandibular and LeFort fractures carried the highest burden (29.2% and 26.4%; p<0.001 vs ZMC/orbital). Smoking, diabetes, higher ASA class, and emergent surgery independently increased odds of complications (all p<0.001). Despite rising acuity over time (higher ASA, more emergent and multifracture repairs), risk-adjusted complication odds remained stable.
CONCLUSION: Stability amid increasing complexity suggests scalable improvements offset baseline risk—standardized perioperative pathways, earlier definitive fixation, optimized anesthesia, infection prevention, and modern fixation strategies. These data establish a national benchmark for performance evaluation by fracture subtype and risk profile. To sustain outcomes as acuity rises, teams should adopt risk-adjusted pathways emphasizing intraoral antisepsis, antibiotic stewardship, early fixation with appropriate hardware, and close surveillance with prompt reintervention for mandibular and LeFort fractures.
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