Inpatient Versus Outpatient Operative Management of Isolated Facial Fractures

Background: Patients with isolated facial fractures requiring operative fixation can be managed on an inpatient or outpatient basis. The goal of this study was to compare the safety of each approach using a large multi-institutional database.

Methods: The American College of Surgeons' National Surgical Quality Improvement Project was reviewed for facial fractures between 2005 and 2018. Groups were identified using inpatient and outpatient status as designated in the database. Patients who required additional procedures, concurrent procedures, or other emergency procedures were excluded. Descriptive statistics were used for group comparisons and logistic regression models were used to identify risk factors for complications.

Results: We identified 4240 patients who underwent operative fixation of isolated facial fractures. The majority of these cases (67.9%) were done on an outpatient basis. Compared to those in the outpatient group, patients in the inpatient group were older, had more medical comorbidities, had higher wound class, and had higher American Society of Anesthesiologists class. Complication (5.9% versus 2.3%), reoperation (4.3% versus 1.7%), and readmission (5.7% versus 2.5%) rates were all higher in the inpatient group (P < 0.01). By logistic regression analysis, the odds ratios for complications, reoperation, and readmission were higher in the inpatient group. After adjusting for imbalanced preoperative patient characteristics, the increased risk of complications [odds ratio (OR) = 1.728, confidence interval (CI) 1.146-2.606, P = 0.01] and the increased risk of reoperation (OR = 2.302, CI 1.435-3.692, P = 0.01) in the inpatient group persisted, while the risk of readmission (OR = 1.684, CI 0.981-2.891, P = 0.06) no longer showed statistical significance between the inpatient and outpatient groups.

Conclusions: Inpatient operative management of isolated facial fractures is associated with an increased risk of complications and a 2-fold increased risk of reoperation, though no increased risk of readmission.