Treatment of Facial Fractures at a Level 1 Trauma Center: Do Medicaid and Non-Medicaid Enrollees Receive the Same Care?

Fazzalari, Amanda; Alfego, David; Shortsleeve, Joseph T.; Shi, Qiming; Mathew, Jomol; Litwin, Demetrius E. M.; Cahan, Mitchell A.

doi:10.1016/j.jss.2020.03.008

Cited by 8 publications

(6 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…At this level 1 trauma center serving a large region, the etiology of the facial trauma is multifactorial, though MVCs and falls were the most common reasons for admission (Figure S2). Identifying the peak season for different anatomic sites of craniofacial fractures is important because mandibular and maxillary fractures most often require surgery 44,45 ; thus, such insights can potentially inform healthcare resource allocation over different time periods, as facial trauma surgeons have highly specialized skillsets and may focus on varying types of fractures.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Craniofacial Trauma Changes With the Seasons

Wilkins,

Shah,

Bourdillon

et al. 2023

FACE

View full text Add to dashboard Cite

Objective: Craniofacial fractures are commonly attributed to exposures that may vary with seasons. While it is commonly thought that summer months tend to have more craniofacial trauma, exact seasonality of such traumas across anatomic sites have not yet been elucidated. We aimed to characterize trends of craniofacial trauma across seasons. Study Design: Retrospective medical record review. Setting: Single-institution study at Level 1 trauma center. Methods: Patient and admission data for craniofacial trauma from June 2013 to June 2019 were systematically extracted by the hospital analyst team using International Classification of Diseases, 10th edition (ICD-10) diagnosis codes. For each ICD-10 diagnosis, anatomic sites affected by trauma were categorized. Trends across seasons and injury site were investigated using Student’s t-test and analysis of variance (ANOVA). Results: Across 925 admissions that met inclusion criteria, the volume of admissions did not significantly differ by season (ANOVA: P = .33). Frequency of admissions for jaw and maxilla fractures was significantly lower in the winter compared to summer (jaw: P = .024; maxilla: P = .018). Number of admissions involving zygoma fractures was lower in the winter compared to summer ( P = .044) and compared to fall ( P = .028). When examining number of fracture sites (eg, 1, 2, or ≥3) for each admission, there was a significantly greater number of admissions with ≥3 fracture sites during summer compared to winter ( P = .017) and fall compared to winter ( P = .011). Conclusion: Rates of craniofacial trauma admissions appear to follow seasonal trends, with significantly fewer craniofacial trauma presentations during winter when compared to summer, especially among non-occipital injuries. These findings, along with future efforts to elucidate seasonal trends nationally, may enable forecasting patterns of fractures to better guide resource allocation and inform prevention strategies.

show abstract

Section: Discussionmentioning

confidence: 99%

Incidence of Craniofacial Trauma Changes With the Seasons

Wilkins,

Shah,

Bourdillon

et al. 2023

FACE

View full text Add to dashboard Cite

show abstract

“…Patient management timeline and hospitalization costs differed significantly by insurance coverage, in accordance with trends reported in the literature. 11,12 Of patients who received ORIF, uninsured and Medicaid patients experienced significantly longer delays in days to ORIF, LOS, and greater admission costs compared to privately insured patients. Delays to surgery in uninsured or publicly-insured patients have been well-described in the literature, and has been attributed to decreased resource utilization in these groups.…”

Section: Discussionmentioning

confidence: 99%

“…Non-private insurance types correlated significantly with increased rates of ORIF, influenced days to ORIF, and were associated with increased cost. Socioeconomic status has been previously associated treatment for facial fractures more broadly 11,12 and has now been further elucidated in treatment of mandibular fractures. The goal of mandible fracture care is to restore form and function including mastication and speech.…”

Section: Discussionmentioning

confidence: 99%

“…In particular, insurance status has well-documented associations with disparities in the timing and delivery of post-trauma care; patients with public insurance experience greater delays receiving surgical care, greater inpatient mortality, receive fewer operative procedures, longer hospital stays, higher rates of readmission, less physical therapy, and worse outcomes overall compared to privately-insured patients. [11][12][13][14][15][16][17] Similarly, decreased early operative intervention among facial fracture patients has been previously demonstrated. 11,12 However, the role of insurance status on mandible fracture management and outcomes is poorly understood.…”

Section: Introductionmentioning

confidence: 99%

“…[11][12][13][14][15][16][17] Similarly, decreased early operative intervention among facial fracture patients has been previously demonstrated. 11,12 However, the role of insurance status on mandible fracture management and outcomes is poorly understood.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Perla

Lopez

Zeyl

et al. 2022

FACE

View full text Add to dashboard Cite

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.

show abstract

Health disparities in facial plastic surgery

Arosarena,

Jegede

2024

Healthcare Disparities in Otolaryngology

View full text Add to dashboard Cite

Treatment of Facial Fractures at a Level 1 Trauma Center: Do Medicaid and Non-Medicaid Enrollees Receive the Same Care?

Cited by 8 publications

References 38 publications

Incidence of Craniofacial Trauma Changes With the Seasons

Incidence of Craniofacial Trauma Changes With the Seasons

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

Health disparities in facial plastic surgery

Contact Info

Product

Resources

About