Insurance Status Influences Mandible Fracture Management and Outcomes: A National Inpatient Sample Analysis of 268 809 Admissions

Abstract

Objective: The aim of this study was to investigate the impact of insurance status on mandible fracture management and outcomes at the national level. Summary: The role of insurance status in mandible fracture management has not been well-characterized. Methods: We conducted a cross-sectional observational study of adults diagnosed with mandibular fractures from 2002 to 2019 using the National Inpatient Sample. Outcomes of interest included open reduction internal fixation (ORIF) surgery versus no intervention, days to ORIF, length of stay (LOS), admission cost, home discharge, and post-operative infection, dehiscence, and hematoma. Multivariable regression was used to compare outcomes by insurance status and race and to adjust for confounders. Results: Around 268 809 patients met inclusion criteria. Most were male (79.6%), white (54.9%), and received ORIF (46.4%). Compared to privately insured patients, uninsured patients had increased odds of undergoing ORIF (OR = 1.21, 95% CI [1.04-1.41]). Compared to privately insured patients, days to ORIF were significantly increased for Medicaid, Medicare, uninsured, and non-White patients (Medicaid = +0.48 days; Medicare = +0.22 days; uninsured = +1.16 days; non-White = +0.58 days; all P < .001 except Medicare). Among ORIF patients, LOS was significantly increased for Medicaid, uninsured, and non-White patients compared to privately insured patients (Medicaid = +1.17 days; uninsured = +2.14 days; non-White = +0.80; all P < .001). Medicaid incurred +$1440.56 greater admission costs compared to privately insured patients ( P < .001). Conclusions: Among adults with mandibular fractures, insurance coverage may influence the time to surgical management, odds of postoperative infection, length of stay, and cost.