Is Treatment at a Level 1 Trauma Center Associated With Better Outcomes in Adults With Isolated Midface Fractures?

Background: Treatment at a level 1 trauma center is associated with better outcomes for a multitude of traumatic injuries. Yet, the relationship between trauma center designation and treatment outcomes in the context of midface trauma remains poorly understood.

Purpose: The purpose of this study was to evaluate the association between trauma center designation and clinical outcomes in patients undergoing an operative intervention for isolated midface trauma.

Study design, setting, sample: This was a retrospective cohort study using the American College of Surgeons National Trauma Data Bank 2018 to 2022. Adults with isolated midface trauma who underwent an operative intervention were included. Patients with polytrauma or missing data were excluded.

Predictor variable: The primary predictor variable was trauma center designation (level 1 or non-level 1).

Main outcome variable: The primary outcome variable was any complication (yes or no). The secondary outcomes were return to the operating room, length of stay, adverse discharge disposition, and days to operation.

Covariates: Covariates were categorized as demographic (age, sex, payer), medical and injury-related (Elixhauser Comorbidity Index, fracture count), and hospital-related (teaching status, bed size).

Analyses: Descriptive, bivariate, and multivariable regression statistics were calculated to measure the association between trauma center designation and outcomes.

Results: Of the 62,437 subjects with isolated midface trauma, 8,321 (13.3%) underwent an operative intervention. There were no significant differences between operation rate between level 1 and non-level 1 trauma centers (odds ratio, 1.01; 95% CI, 0.95 to 1.08). The operative cohort had a mean age of 44.8 ± 18.5 years, and 5,941 were male (71.4%). The complication rates at level 1 and non-level 1 trauma centers were 1.1% (58) and 1.0% (33) respectively, and this difference was not significant (relative risk 1.08; 95% CI, 0.71 to 1.67, P = .8). After adjusting for study covariates, trauma center designation was not independently associated with complications, hospital length of stay, return to the operating room, adverse discharge disposition, or days to operation.

Conclusion and relevance: Trauma center designation was not independently associated with clinical outcomes. Further studies are necessary to determine which patients would benefit most from treatment at a level 1 trauma center.