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JOMS study: Outpatient jaw fracture treatment reduces hospital stay without raising complication risk

November 2, 2020

ROSEMONT, Ill. – A new study presents an outpatient treatment strategy for lower jaw fractures that shortens the patient’s hospital stay by more than two days without increasing the risk of postsurgical inflammatory complications compared to inpatient treatment. 

The shorter hospital stay for outpatient care compared to inpatient care “may be clinically significant” because length of stay has been linked to complications including infection, according to the study published in the November issue of the Journal of Oral and Maxillofacial Surgery, the official journal of the American Association of Oral and Maxillofacial Surgeons (AAOMS). A shorter hospital stay also could save money – the study notes the average cost of a three-day stay for a lower jaw fracture is almost $36,000. 

Typically, lower jaw fractures have been treated within 72 hours with immediate hospital admission to lower infection risk and discomfort as well as to ease setting of the fracture – yet, patients are traditionally admitted for days while awaiting treatment, the study notes. Researchers examined data at their institution, Massachusetts General Hospital, which has moved toward outpatient jaw fracture treatment. 

The study involved 193 patients with lower jaw fractures who underwent surgery known as open reduction-internal fixation (ORIF) that uses hardware, such as metal screws and plates, to keep the bones in place after the surgeon realigns the bone. 

In the outpatient group, 82 patients received a closed reduction and intermaxillary fixation (CR-IMF) – namely, wiring the jaws together to stabilize the fracture – in the emergency department or an outpatient clinic before they were discharged and scheduled for elective ORIF within a week if possible. 

In the inpatient group, 111 patients were admitted to the hospital and did not receive a CR-IMF before they underwent ORIF in an operating room as soon as possible. 

Researchers found those in the outpatient group were in the hospital “significantly fewer days” – more than two – than those in the inpatient group. For traditional inpatient care, surgery is often delayed due to needed other treatments or unavailability of the surgeon or the operating room, the study notes. 

The study results also showed no significant difference in major or minor postsurgical inflammatory complications – such as infection and hardware removal – between the two groups. Complication frequency was 17.1 percent for the outpatient group and 18.9 percent for the inpatient group. 

“Collectively, the information in this study could be useful for institutions seeking to develop or modify their protocols with respect to management of isolated mandibular fractures,” researchers wrote.  

The authors of “Can Patients With Isolated Mandibular Fractures Be Treated as Outpatients” are Cameron C. Lee, DMD, MD, and Matthew E. Lawler, DMD, MD, from Massachusetts General Hospital in Boston, Mass., R. John Tannyhill, DDS, MD, from Massachusetts General Hospital and Harvard School of Dental Medicine in Boston; Thomas B. Dodson, DMD, MPH, from the University of Washington School of Dentistry and University of Washington Medical Center in Seattle, Wash.; and Zachary S. Peacock, DMD, MD, from Massachusetts General Hospital and Harvard School of Dental Medicine. 

The full article can be accessed at JOMS.org/article/S0278-2391(20)30677-7/fulltext

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The Journal of Oral and Maxillofacial Surgery is published by the American Association of Oral and Maxillofacial Surgeons to present to the dental and medical communities comprehensive coverage of new techniques, important developments and innovative ideas in oral and maxillofacial surgery. Practice-applicable articles help develop the methods used to handle dentoalveolar surgery, facial injuries and deformities, TMJ disorders, oral and head and neck cancer, jaw reconstruction, anesthesia and analgesia. The journal also includes specifics on new instruments and diagnostic equipment, and modern therapeutic drugs and devices.