A retrospective analysis of risk factors of oromaxillofacial infection in patients presenting to a hospital emergency ward

Abstract

BackgroundThe purpose of this study was to review the clinical features of oromaxillofacial infections in patients presenting to a hospital emergency ward, to identify the key factors affecting the requirement for hospitalization, and the potential risk factors predisposing to a prolonged length of hospital stay.MethodsA retrospective medical record review of the 598 patients treated for oromaxillofacial infection from 2013 to 2017 at the oral and maxillofacial surgery department, Yangsan Pusan National University Hospital, was conducted. The following information was collected from each patient: sex, age, past medical history, site of infection, etiology, admission or outpatient care, level of C-reactive protein (mg/dL), fascial spaces involved, treatment method, and duration of hospitalization. Chi-squared tests were used to identify risk factors, which were further analyzed using multivariable logistic regression.ResultsA total of 606 patients were eligible for inclusion in the study, of which eight were excluded due to having incomplete charts; thus, 598 patients were included: 55% were male, mean patient age was 47.1 ± 19.9 years, and 12.9% of patients were diabetic. Furthermore, 71.2% of patients had infection originating in the mandible; the most common tooth of origin was lower posterior, and 29.8% of patients were hospitalized. Risk factors for hospital admission were elderly patients with concurrent disease, elevated C-reactive protein level, and multiple-space infection in the oromaxillofacial area. The duration of hospitalization was correlated with both diabetes and age.ConclusionsThe requirement for hospital admission is determined by the severity of the infection; even severe infections, once treated with appropriate surgery, have no relation to the length of hospital stay. The important risk factors for increased duration of hospitalization are diabetes mellitus and older age. The understanding of risk factors associated with a prolonged hospital stay during the treatment of oromaxillofacial infection will aid in treatment planning as well as highlight the importance of adequate diabetes control in patients at risk of such infection.

Factors associated with treatment outcomes of patients hospitalized with severe maxillofacial infections at a tertiary center

“…Most cases in the current study (97.2%) were due to odontogenic causes. This is in accordance with a previous Korean review that reported the rate of maxillofacial infections due to odontogenic infections in Korea to be 92.47% 17 . However, this figure is much higher than those previously documented by other researchers for hospitalized patients of 61.8% to 71.0% 7 , 13 , 14 , 16 , 20 .…”

“…Average LOS in this study was 11.47 days. While this is in accordance with studies conducted in South Korea 17,21,22 and other Eastern countries 18,20 , this was a nearly two-to four-fold higher rate than the figures reported for Western populations. A previous study based on national data that investigated the treatment outcomes of patients in the USA admitted with mouth cellulitis reported an average LOS of only 3.9 days 12 .…”

“…This is a significantly older age than reported in previous studies 1 - 3 , 5 8 , 11 - 18 , which reported severe maxillofacial infections around the fourth and fifth decades of life. This is also higher than the reported mean age of 47.13 years in a previous Korean study by Park and colleagues on maxillofacial patients who presented to the ER 17 . The relatively older average age of the patients in the present study can be attributed to the rapid aging of the Korean population in the recent years, which has been reported to be the fastest among OECD (Organisation for Economic Co-operation and Development) countries, with the share of the population aged 65 and above expected to exceed one-third by 2050 19 .…”

“…Not surprisingly, variables related to involvement of multiple anatomical sites such as infection side, Flynn score, and presence of deep neck infection were significantly correlated with longer LOS and higher costs. The association between multi-space infections and longer stay in the hospital in addition to higher hospital bills has been documented in several previous reports 3,12,17,28 . We also found that a delay in surgical intervention was associated with a longer stay, indicating the importance of prompt surgery when deemed necessary.…”

“…Of note is our finding that admission serum glucose level was significantly associated with overall LOS and hospital costs. The significant correlation between elevated serum glucose level due to diabetes and longer hospital stay, increased possibility of severe complications, and poorer treatment outcomes of maxillofacial infection patients has been documented in several previous studies 3,12,17,20 . This relationship has been attributed to poor tissue perfusion with a subsequent delay in wound healing and immune system dysregulation 5,20 .…”