Insurance Status Influences Mandible Fracture Management And Outcomes: A National Inpatient Sample Analysis Of 268,809 Admissions
Krissia M. Rivera Perla*, MPH1, Christopher D. Lopez*, MD2, Alisa O. Girard, MBS2, Victoria G. Zeyl, BA1, Richard J. Redett, MD2, Paul N. Manson, MD2, Robin Yang, DDS, MD2.
1Division of Plastic Surgery, Department of Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA, 2Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
* Denotes co-first authorship
Purpose: The role of insurance status in mandible fracture management has not been well-characterized. The purpose of this study was to investigate the impact of insurance status on mandible fracture management and outcomes at the national level.
Methods: We conducted a cross-sectional study of adults diagnosed with mandibular fractures from 2002 to 2017 using the National Inpatient Sample. Outcomes of interest included open vs. closed intervention, time to intervention, length of stay (LOS), admission cost, home discharge, and post-operative infection, dehiscence, and hematoma. Multivariable regression was used to adjust for treatment modality (open or closed) and other confounders.
Results: 268,809 patients met inclusion criteria. Most were male (79.6%), white (54.9%), and received operative intervention (70.1%). Compared to privately insured patients, Medicaid and Medicare patients had decreased odds of undergoing either open or closed treatment (OR=0.86, 95%CI=[0.81-0.92] and 0.85, 95%CI=[0.78-0.93] respectively). Among those who received intervention, Medicaid patients had greater odds of postoperative infection (1.65 [1.003-2.71]) and incurred $1,851.60 greater admission costs compared to privately insured patients. Medicaid and uninsured patient status were predictive of delayed intervention (both p<0.001) and longer LOS (both p<0.001).
Conclusions: Among adults with mandibular fractures, insurance coverage may impact the time to surgical management, odds of post-operative infection, length of stay, and cost. 
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