Trends in Management and Cost Burden of Facial Fractures: A 14-Year Analysis.

OBJECTIVE: To discuss patient demographics and management and better understand the economic impact associated with the treatment of facial fractures at a major metropolitan level 1 trauma center. STUDY DESIGN: Retrospective chart review. METHODS: We identified 5088 facial fractures in 2479 patients who presented from 2008 to 2022. Patient demographics, mechanism of injury, associated injuries, treatment information, and hospital charges were collected and analyzed to determine factors associated with surgical management and increased cost burden. RESULTS: Our 14-year experience identified 1628 males and 851 females with a mean age of 45.7 years. Orbital fractures were most common (41.2%), followed by maxilla fractures (20.8%). The most common mechanism was fall (43.0%). Surgical management was recommended for 41% of patients. The odds of surgical management was significantly lower in female patients, patients age 65 and older, and patients who presented after the onset of the COVID-19 pandemic. The odds of surgical management was significantly higher for patients who had a mandible fracture or greater than 1 fracture. The average cost of management was highest for naso-orbito-ethmoidal fractures ($37,997.74 ± 52,850.88), followed by LeFort and frontal fractures ($29.814.41 ± 42,155.73 and $27,613.44 ± 39.178.53, respectively). The highest contributor to the total average cost of management was intensive care unit-related costs for every fracture type, except for mandible fractures for which the highest contributor was operating room (OR)-related costs. CONCLUSIONS: This study represents one of the largest comprehensive databases of facial fractures and one of the first to provide a descriptive cost analysis of facial trauma management. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:3120-3126, 2024.

Treatment of Facial Fractures at a Level 1 Trauma Center: Do Medicaid and Non-Medicaid Enrollees Receive the Same Care?

BACKGROUND: Timing of surgical treatment of facial fractures may vary with the patient age, injury type, and presence of polytrauma. Previous studies using national data sets have suggested that trauma patients with government insurance experience fewer operations, longer length of hospital stay (LOS), and worse outcomes compared with privately insured patients. The objective of this study is to compare treatment of facial fractures in patients with and without Medicaid insurance (excluding Medicare). METHODS: All adults with mandibular, orbital, and midface fractures at a Level 1 Trauma Center between 2009 and 2018 were included. Statistical analyses were performed to assess the differences in the frequency of surgery, time to surgery (TTS), LOS, and mortality based on insurance type. RESULTS: The sample included 1541 patients with facial fractures (mandible, midface, orbital), of whom 78.8% were male, and 13.1% (208) were enrolled in Medicaid. Mechanism of injury was predominantly assault for Medicaid enrollees and falls or motor vehicle accidents for non-Medicaid enrollees (P < 0.001). Patients with mandible and midface fractures underwent similar rates of surgical repair. Medicaid enrollees with orbital fractures underwent less frequent surgery for facial fractures (24.8% versus 34.7%, P = 0.0443) and had higher rates of alcohol and drug intoxication compared with non-Medicaid enrollees (42.8% versus 31.6%, P = 0.008). TTS, LOS, and mortality were similar in both groups with facial fractures. CONCLUSIONS: Overall, the treatment of facial fractures was similar regardless of the insurance type, but Medicaid enrollees with orbital fractures experienced less frequent surgery for facial fractures. Further studies are needed to identify specific socioeconomic and geographic factors contributing to these disparities in care.

Cost Analysis of Implants in the Surgical Repair of Orbital Floor Fractures.

OBJECTIVE: Options for the management of orbital floor fractures continue to evolve offering both potential advantages as well as higher costs. To date, the effect of implant choice on the cost associated with the repair of orbital floor fractures has not been studied. METHODS: A retrospective review at a tertiary care, level I trauma center examining all adult, uncomplicated orbital floor fractures that underwent open reduction and internal fixation from 2013 to 2016. Patients with concurrent operative facial fractures were excluded. The main outcomes were overall cost of care from injury to last follow-up and operating room-related costs. Costs were determined using computerized records of charges as well as the hospital Charge Description Master. Kruksal-Wallis rank sum tests were used to analyze for differences between groups. RESULTS: Twenty-eight patients fulfilled the inclusion criteria. Eight different stock, non-patient specific, implants were used for repair. The cost of individual types of implants ranged from $70.25 to $7 718.00. Total cost of care per patient across all implant types averaged $35 585.57 (range $25 586.26 to $49 985.74, P = .34). Operation-related charges accounted for the vast majority (94.4%) of the total cost of care. One complication occurred requiring operative re-positioning of the implant with an additional $13 042.41 in charges. CONCLUSIONS: In the setting of uncomplicated orbital floor fractures, surgeons should select an implant that allows them to carry out the repair in a safe, timely fashion. Additional large-scale studies would help to further delineate cost differences.

Template-Based Orbital Wall Fracture Treatment Using Statistical Shape Analysis.

PURPOSE: Aim of this study was to investigate whether a mold generated from a statistical shape model of the orbit could be generated to provide a cost-efficient means for the treatment of orbital fractures. MATERIALS AND METHODS: A statistical shape model was created from 131 computed tomographic (CT) scans of unaffected adult middle European human orbits. To generate the model, CT scans were segmented in Brainlab software, preregistered using anatomic landmarks, trimmed to an identical size, and definitely registered. Then, the model was created using the global master algorithm. Based on this model, a mold consisting of a male part and a female part was constructed and printed using a rapid prototyping technique. RESULTS: A statistical shape model of the human orbit was generated from 125 CT scans. Six scans (4.5%) presented major anatomic deviations and were discarded. A solid mold based on this model was printed. Using this mold, flat titanium mesh could be successfully deformed to serve as an orbital implant. CONCLUSION: A mold based on the statistical orbital shape could serve as a cost-effective means for the treatment of orbital fractures. It allows the anatomic preformation of titanium or resorbable implant material for orbital reconstruction. Because these materials could be cut from larger sheets, the use of a mold would be a cost-effective treatment alternative.

Low-Cost 3D Printing Orbital Implant Templates in Secondary Orbital Reconstructions.

PURPOSE: Despite its increasing use in craniofacial reconstructions, three-dimensional (3D) printing of customized orbital implants has not been widely adopted. Limitations include the cost of 3D printers able to print in a biocompatible material suitable for implantation in the orbit and the breadth of available implant materials. The authors report the technique of low-cost 3D printing of orbital implant templates used in complex, often secondary, orbital reconstructions. METHODS: A retrospective case series of 5 orbital reconstructions utilizing a technique of 3D printed orbital implant templates is presented. Each patient's Digital Imaging and Communications in Medicine data were uploaded and processed to create 3D renderings upon which a customized implant was designed and sent electronically to printers open for student use at our affiliated institutions. The mock implants were sterilized and used intraoperatively as a stencil and mold. The final implant material was chosen by the surgeons based on the requirements of the case. RESULTS: Five orbital reconstructions were performed with this technique: 3 tumor reconstructions and 2 orbital fractures. Four of the 5 cases were secondary reconstructions. Molded Medpor Titan (Stryker, Kalamazoo, MI) implants were used in 4 cases and titanium mesh in 1 case. The stenciled and molded implants were adjusted no more than 2 times before anchored in place (mean 1). No case underwent further revision. CONCLUSIONS: The technique and cases presented demonstrate 1) the feasibility and accessibility of low-cost, independent use of 3D printing technology to fashion patient-specific implants in orbital reconstructions, 2) the ability to apply this technology to the surgeon's preference of any routinely implantable material, and 3) the utility of this technique in complex, secondary reconstructions.

Orbital fractures: national inpatient trends and complications.

PURPOSE: The present study aimed to examine cost, demographics, and short-term complications associated with orbital fractures and their surgical repair in the inpatient population in the United States over a 7-year period. METHODS: A retrospective cohort study was performed by using the Nationwide Inpatient Sample from 2002 to 2008 and searching the database for discharges classified with International Classification of Disease-9 diagnosis codes of orbital fractures, orbital fracture repair, and associated diagnoses. RESULTS: There was nearly a 50% increase in the annual number of orbital fracture admissions from 2002 to 2008. Demographics for patients with orbital fractures showed that 68% of them were male, most commonly between 18 and 44 years of age, with 69% of cases at large teaching hospitals. Associated ocular diagnoses included eyelid laceration, commotio retinae, and globe rupture. Approximately 25% of patients underwent surgical repair. Surgical patients were younger than nonsurgical patients by approximately 10 years. An overall complication rate of 15.8% was noted, including: pulmonary complications, diplopia, renal impairment, venous thromboembolism, and wound complications. Orbital fracture repair was associated with approximately 1 extra day of hospitalization and $22,000 in-hospital charges. The rates of pulmonary, wound, and ocular motility complications were significantly higher in the patients undergoing orbital fracture repair (p<0.05). CONCLUSIONS: The number of orbital fractures and associated cost has dramatically increased over the past decade. Acute repair of orbital fractures is common and is associated with a longer hospital course, increased cost, and higher rate of complications.