(100) Evaluation of Non-Surgical Site Complications Following Mandibular Fracture Repair Among Elderly Patients

Abstract:

Introduction: Although much of the literature on complications following open reduction and internal fixation (ORIF) of mandibular fractures focuses on surgical site-related issues, some studies have also examined non-surgical factors such as malnutrition, psychosocial effects, and systemic infections. This study assessed the prevalence, types, and risk factors of non-surgical site complications in patients after surgical repair of mandibular fractures.
Materials and

Methods: A retrospective cohort study was conducted at the University Medical Center New Orleans Hospital between 2018-2023. Patients aged 16 and older who underwent ORIF for mandibular fractures were included. The primary predictor variable was patient age ( < 60 vs ≥60 years), and other patient/injury-related factors were assessed. The primary outcome was the presence of non-surgical site complications, categorized into types such as pulmonary, urinary, infection, electrolyte imbalance, cardiac, gastrointestinal, and other. Statistical analyses included descriptive statistics, risk ratio calculations, and univariate/multivariate logistic regression.

Results: Among 884 patients (82.5% male, 94.2% < 60 years), 73 (8.26%) experienced non-surgical complications. Patients ≥60 years had a 2.30 times higher risk of complications than younger patients. Univariate analysis showed higher odds of complications for those ≥60 years (OR = 2.57), with associated injuries (OR = 4.78), and other facial fractures (OR = 4.11). After adjustment, age was no longer significant, but associated injuries (aOR = 3.56) and outpatient status (aOR = 0.35) remained significant predictors. Common complications were gastrointestinal (27.9%), cardiac (19.8%), and other (38.4%), occurring within 0-13 days post-surgery. Complications were associated with longer hospital stays (median 4 days longer, P < .001).

Conclusion: Non-surgical complications were observed in 8.26% of patients after mandibular fracture ORIF. Notably, the complication rate was significantly higher in patients aged ≥60 years compared to those <60 years, emphasizing the increased vulnerability of older adults to such complications. While they constituted a smaller portion of the overall sample, their risk for developing complications was more than double that of their younger counterparts, highlighting age as a critical factor in postoperative outcomes. The findings suggest that younger patients experienced a lower incidence of complications, possibly due to better physiological resilience and lower rates of comorbidities. This underscores the need for heightened postoperative monitoring and tailored care strategies for older patients, particularly those with associated injuries or multiple facial fractures, to mitigate the risk of non-surgical complications. Addressing these risk factors may enhance recovery and reduce hospital stays for this demographic.