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Repair of Facial Fractures - An Age or Socioeconomic Bias?
*Daithi S Heffernan, *Elizabeth Steubing, *Sean F Monaghan, *Michael D Connolly, *Shea C Gregg, *Andrew Steven, *Charles A Adams, Jr., William G Cioffi
Brown University / Rhode Island Hospital, Providence, RI
Objective: The population is rapidly aging and increasingly uninsured. Trauma is perceived as associated with low socioeconomic status (SES). The Institute of Medicine reported that low SES patients suffer worse outcomes from a variety of diseases. Plastic surgeons and otorhinolaryngologists are dependent on fee-paying, young patients in whom cosmesis is important. We hypothesize that facial fracture operative repair will preferentially occur in young, high SES compared with geriatric or low SES patients.
Design: 5 year retrospective chart review
Materials and Methods: Zip code (thus income from US Census) of residency as a marker for socioeconomic status. Data on facial fracture sustained, operative repair and whether operative repair was inpatients or outpatient.
Setting: Level 1 Trauma Center
Patients: Admitted Trauma patients 18 years and older who sustained facial fractures with an Face Abbreviated Injury Severity (AIS) score of >/=2 (out of 5)
Results: 598 patients were included. No patient that died had their facial fractures repaired. Groups were matched for Injury Severity Score [18-35years = 17; 35-65years= 18; >65years =15 (p=0.56]). Of those under 35 years, 48% (102/210) underwent operative repair, significantly higher than 35 and 65 year olds, 35% (88/247) were repaired (P=0.006). Only 9 of 113 (7.9%) of the geriatric (>65yrs) patients underwent repair (P<0.0001). However, age did not affect inpatient versus outpatient repair. Conversely, there was no significant difference in operative repair rates between high and low socioeconomic status, even after excluding geriatric patients.
Conclusion: Age significantly affects decisions regarding operative repair of facial fractures, true even in middle aged compared to younger adults. Unlike diseases such as cancer and cardiovascular disease, SES does not appear to impact operative repair of facial trauma.
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