Is Treatment at a Level 1 Trauma Center Associated With Better Outcomes Among Patients With Isolated Mandible Fractures?

Background: The trauma literature suggests that treatment at a level 1 trauma center is associated with improved outcomes for a diversity of injuries. However, differences in outcomes with respect to trauma center designation are poorly studied in the facial trauma demographic.

Purpose: The purpose of this study was to measure the association between trauma center designation and clinical outcomes in patients undergoing management of isolated mandible fractures.

Study design, setting, sample: This was a retrospective cohort study using the 2018 to 2022 American College of Surgeons National Trauma Data Bank. Adult patients with an isolated mandibular fracture undergoing open reduction internal fixation or closed reduction were included. Patients missing demographic or outcomes data were excluded.

Predictor/exposure/independent variable: The primary predictor was trauma center designation (level 1 or nonlevel 1).

Main outcome variable: The primary outcome was any complication. Secondary outcomes were return to the operating room, length of stay, adverse discharge disposition, and specific complications.

Covariates: Covariates were categorized into demographic (age, sex), medical (Elixhauser Comorbidity Index), injury severity, operative intervention (open reduction internal fixation or closed reduction), and hospital characteristics (teaching status, bed size).

Analyses: Descriptive, bivariate, and multiple regression statistics were performed to evaluate the association between trauma center designation and outcomes.

Results: The cohort was composed of 28,897 subjects with a mean age of 35.1 ± 14.0 years, and 23,718 were male (82.1%). There were 16,788 (58.1%) and 12,109 (41.9%) subjects treated at level 1 and nonlevel 1 trauma centers, respectively. Complication rates were 1.10% (188) and 1.00% (120) at level 1 and nonlevel 1 trauma centers, respectively (relative risk: 0.88; 95% confidence interval: 0.70 to 1.11; P = .3). After adjusting for demographic, medical, injury severity, operative intervention, and hospital characteristic covariates, treatment at a level 1 trauma center was not independently associated with complications, nor was it associated with return to the operating room, length of stay, or adverse discharge disposition.

Conclusions and relevance: Trauma center designation was not an independent predictor of adverse outcomes. Additional studies are needed to identify which patients will benefit most from treatment at a level 1 trauma center in this demographic.