Timing of Dietary Progression After Mandibular Fracture Repair: The Role of Comorbidities and Their Impact on Postoperative Outcomes.

Aim: This retrospective study evaluated whether the timing of dietary progression after mandibular fracture repair influences postoperative complications (wound dehiscence, infection, and reoperation) and assessed how comorbidities, specifically diabetes and chronic kidney disease (CKD), affect these outcomes.

Methods: A retrospective observational analysis was conducted of 1023 patients who underwent open reduction and internal fixation (ORIF) for mandibular fractures between 2012 and 2023. Patients were categorised into Early (<3 weeks), Standard (3 weeks), and Delayed (>4 weeks) groups according to the interval before the introduction of a solid diet. Postoperative complications were evaluated using multivariate logistic regression models adjusted for diabetes, CKD, and smoking.

Results: Early dietary progression was initially associated with higher rates of wound dehiscence (15.2% vs. 9.6% vs. 6.6%) and reoperation (8.2% vs. 2.0% vs. 1.6%) than the Standard and Delayed groups (p < 0.05) in univariate analysis. However, after adjusting for confounders in multivariate analysis, CKD emerged as the strongest independent predictor of wound dehiscence (odds ratio (OR) = 2.77, p < 0.001), whereas the impact of early dietary advancement was no longer statistically significant (adjusted OR = 1.08, p = 0.58). Multivariate analysis also identified CKD as an independent predictor of both infection and reoperation, with affected patients having an odds ratio of 3.85 for requiring reoperation (p < 0.001), highlighting the impact of systemic metabolic dysfunction on postoperative complications. Diabetes showed a borderline association with wound dehiscence, although it did not reach statistical significance (OR = 1.59, p = 0.067).

Conclusions: Although early reintroduction of solid foods initially appeared to increase postoperative complications, CKD was identified as the primary independent predictor of impaired wound healing when adjusting for comorbidities. Progression to a solid diet after approximately three weeks appears generally safe; however, patients with CKD or diabetes may benefit from individualised dietary protocols that minimise mechanical stress on the fracture site. Prospective studies are recommended to validate these findings and refine dietary guidelines, based on individual patient risk profiles.