Treatment of Facial Fractures at a Level 1 Trauma Center: Do Medicaid and Non-Medicaid Enrollees Receive the Same Care?
*Amanda Fazzalari, *David Alfego, *Joseph Taylor Shortsleeve, *Qiming Shi, *Jomol Mathew, Demetrius Litwin, Mitchell A. Cahan
University of Massachusetts Medical School, Worcester, MA
Objective: Timing of surgical treatment of facial fractures may vary with patient age, injury type, and presence of polytrauma. Previous studies using national datasets have suggested that trauma patients with government insurance experience fewer operations, longer length of hospital stay (LOS), and worse outcomes compared to privately insured patients.
The objective of this study is to compare frequency of surgery, time to surgery (TTS), LOS between patients with and without Medicaid insurance who suffer from facial fractures.
Design: Retrospective cohort study.
Setting: Level 1 Trauma Center.
Patients: All adult patients (N=1,336) with mandibular (n=220), orbital (n=536), and midface (n=580) fractures between 2009-2018. Statistical analyses were performed to assess differences in frequency of surgery, TTS, LOS, and mortality between Medicaid and Non-Medicaid enrollees (excluding Medicare).
Main Outcome Measures: Frequency of surgical treatment for facial fracture, TTS, LOS, and mortality.
Results: Of the patients included 78.8% were male, 83.5% were Caucasian, and 13.1% (175) were enrolled in Medicaid. Mechanism of injury was predominantly assault for Medicaid enrollees and falls or motor vehicle accidents for Non-Medicaid enrollees (p<0.001). Both groups exhibited similar comorbidities, GCS, and rates of ICU admission. 496 patients underwent operative fracture treatment, with similar rates of surgery for mandibular and midface fractures between groups (p=0128). Medicaid enrollees with orbital fractures were less likely to undergo surgical correction (19.4 vs 34.5%, p=0.016), despite similar fracture complexity. TTS, LOS, and mortality were similar in both groups.
Conclusions: Medicaid enrollees experienced less frequent operations for orbital fractures, despite similar fracture complexity and severity. Further studies are needed to identify social and geographic factors that may influence treatment of facial fractures among Medicaid and Non-Medicaid enrollees.
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