Open Reduction and Internal Fixation of Mandibular Fractures in a Nonhospital Surgical Facility: Retrospective Chart Review.

Abstract

Background: Many patients with mandibular fracture need treatment with open reduction and internal fixation (ORIF). These patients are typically treated in hospital, as either inpatients or day surgery patients. However, it is possible to perform these surgeries in a nonhospital surgical facility (NHSF). In this study, we review the outcomes of ORIF surgery for mandibular fracture performed in an NHSF.

Methods: A retrospective chart analysis was conducted for all patients with mandibular fracture who were referred, between 2019 and 2024, to an NHSF in Edmonton, Alberta, Canada, for ORIF. Data were collected for patient- and injury-related variables, including cause of trauma; fracture location; time from injury and diagnosis to ORIF; time in the operating room and post-anesthesia care unit (PACU); complication rates for nausea, vomiting, pain or bleeding in the PACU; rates of same-day discharge, hardware failure, non-union and infection; and length of postoperative follow-up. A cost analysis was also conducted.

Results: A total of 69 patients with mandibular fracture who underwent ORIF as day surgery in an NHSF met the inclusion criteria. The mean times from injury to ORIF and from fracture diagnosis to ORIF were 6.0 and 2.5 days, respectively. The mean times spent in the operating and recovery rooms were 61.6 and 62.2 minutes, respectively. All of the patients were discharged home, and no patients experienced surgical or anesthesia complications requiring transfer to a hospital. The cost analysis showed that performance of ORIF was more cost-effective in an NHSF than in hospital.

Conclusion: These preliminary data are the first in Canada suggesting that for selected cases of mandibular fracture, ORIF in an NHSF is efficient, safe and cost-effective, provided stringent patient selection criteria and postoperative protocols for discharge are followed.