SA1 - The Corticosteroid Controversy: Can Surgeons Shorten Hospital Stay for Odontogenic Infection Patients?

Abstract: Effective management of odontogenic infections is critical in oral and maxillofacial surgery. Methods to improve surgical and medical outcomes for these patients are often addressed by the length of hospital admission. One frequently debated practice is the decision to administer corticosteroids after surgery. A physiological benefit of corticosteroids is the potential to reduce edema and pain, which may shorten recovery time. However, the advantages to administer are often disregarded due to the potential consequences of immunosuppression. While literature supports pre-surgical administration of low-dose corticosteroid for airway edema or postoperative nausea and vomiting (PONV) protocols, there is minimal data of post-surgical use for odontogenic infections.
This study aimed to assess the relationship between post-surgical corticosteroid administration and hospital length of stay, hypothesizing that the drug benefit would lead to shorter stays. Additionally, data was recorded to analyze if steroid administration had an impact on variables such as age, gender, ASA status, severity of infection, and pre-existing medical conditions.
A retrospective chart review was completed of patients admitted for surgical and medical management of odontogenic infections at The Ohio State University Wexner Medical Center between 2017 and 2023. Minors and patients with an infection secondary to pathology or bone necrosis conditions were excluded. Specific to corticosteroids, the patient must have received ≥ 10 mg dexamethasone at least ≧ 1 day(s) post-surgery (not administered for pre-intubation airway edema or PONV). Other compiled data included: age, gender, length of stay (LOS), ASA level, diabetes, smoking status, white blood cell (WBC) and blood glucose (BG) values upon presentation, and presence of autoimmune comorbidity. In addition, patients were categorized by severity of infection based on the previous criteria published by Flynn et al.
Descriptive statistics were conducted to analyze the administration of post-surgical corticosteroids and severity using means and standard deviations for continuous variables, and frequencies and percentages for categorical variables. Characteristics were compared by steroid or severity groups using t-test, Kruskal-Wallis test (for continuous variable that is not normally distributed) and Chi-square tests. Univariate and multivariate analyses were conducted using general linear models to assess the effect of steroid and severity on LOS. In the multivariate model, ASA status, age, autoimmune disease, BG and WBC levels, diabetes, gender, and smoking status were included as covariates (α = 0.05, Tables 1-3). All analyses were conducted using SAS (version 9.4).

In total, 456 patients met inclusion criteria and pertinent findings included the following. 314 patients (69%) were classified as moderate severity, whereas 142 (31%) were severe. Severe category patients had a significantly longer LOS (7.77 vs 5.13 days, p 100, and WBC count >11. Sex and smoking status did not show statistically significant effects on LOS.
The most substantial variables that influenced the length of stay included pre-treatment concomitant autoimmune disorders, elevated blood glucose and white blood cell counts, which are not amenable to improvements in surgical practice. Our hypothesis that administering postsurgical corticosteroids would shorten hospital stay, did not demonstrate statistical significance. Patients with pre-existing immunosuppressive conditions did not have a longer hospital stay after postsurgical corticosteroid administration, which may help address concerns about the negative effect of the medication.
1. Neal TW, Hammad Y, Carr BR, Schlieve T. The Cost of Surgically Treated Severe Odontogenic Infections: A Retrospective Study Using Severity Scores. J Oral Maxillofac Surg. 2022;80(5):897-901. doi:10.1016/j.joms.2022.01.001

2. Flynn TR, Shanti RM, Levi MH, et al: Severe odontogenic infections, Part 1 and Part II: Prospective report. J Oral Maxillofac Surg 64: 1093, 2006
Table 1: Effects of STEROID on Length of Stay (LOS) from Univariate and Multivariate Analysis Table 2: Effects of SEVERITY on Length of Stay (LOS) from Univariate Multivariate Analysis Table 3: Effects of variables of than STEROID on Length of Stay (LOS) from Univariate and Analysis