University of Minnesota University of Minnesota Minneapolis, Minnesota
Educational Objective: At the conclusion of this presentation, the participants should be able to describe current national patterns in inpatient hospital management of mandible fractures, recognize common complications requiring inpatient readmission, and identify patient and system related factors associated with increased healthcare utilization.
Objectives: To report the incidence and reasons for 30 day readmissions following initial hospitalization for management of a fractured mandible and to identify predictive factors that lead to significantly higher rehospitalization risk.
Study Design: Retrospective cross-sectional analysis of the 2017 Nationwide Readmissions Database (NRD).
Methods: Relevant ICD-10 codes were used to identify patients who underwent an index hospitalization for mandible fracture. Univariate analysis was performed with chi square and independent Student t-test. Using multivariate logistic regression, independent predictors of 30 day readmission were identified.
Results: We identified 10,991 patients who were admitted for inpatient management of a mandible fracture, of which 292 (2.4%) were readmitted within 30 days of discharge from initial hospitalization (mean age 39.8+/-19.0 years, 78% male). Independent predictors of 30 day readmission were open fractures (OR: 1.54, 95% CI: 1.11-2.10, p=0.008), cigarette smoking (OR: 1.55, CI: 1.16-2.06, p=0.003), opioid use disorder (OR: 2.04, CI: 1.22-3.29, p=0.005), homelessness (OR: 2.32, CI: 1.47-3.59, p<0.001), concurrent mental health diagnosis (OR :2.31, CI: 1.74-3.05, p<0.001), anticoagulant medication use (OR: 2.11, CI: 1.27-3.41, p=0.003), liver disease (OR: 2.25, CI: 1.21-3.94, p=0.007), and presence of a tracheostomy (OR: 25.80, CI: 11.67-56.01, p<0.001). Fractures of the angle (OR: 3.05, CI: 2.12-4.39, p<0.001) and symphysis (OR: 2.97, CI: 2.05-4.30, p<0.001) were the subsites most associated with readmission. Operative intervention during the initial hospitalization (OR: 0.30, CI: 0.21-0.41, p<0.001) and longer duration of stay (OR: 0.91, CI: 0.88-0.94, p<0.001) were associated with decreased risk of readmission. The most common reason for readmission was infection (n=61/292, 21%).
Conclusions: Risk factor modification of the described independent predictors of 30 day readmission may improve outcomes and allow for recognition of the patients most at risk for post-injury readmission after a mandible fracture.