Can elective surgery for mandibular and zygomatic complex fractures reduce overall hospital stay without compromising outcomes? Analysis of administrative datasets by the GIRFT programme |
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| Institution: | 1. Getting It Right First Time programme, NHS England and NHS Improvement, London, UK;2. East Lancashire Hospitals NHS Trust, Blackburn, UK;1. University Hospitals Bristol;2. Oral and Maxillofacial Surgery, University Hospitals Bristol;1. State Key Laboratory of Oral Diseases & National Clinical Research Centre for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, 14 Ren Min Nan Road, Chengdu, 610041, PR China;2. Department of Orthodontics, Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, No. 639 Zhizaoju Road, Shanghai, PR China;3. State Key Laboratory of Oral Diseases & National Clinical Research Centre for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, 14 Ren Min Nan Road, Chengdu, 610041, PR China;1. Service de chirurgie Maxillo-faciale et stomatologie, CHU de Nantes, 1 place Alexis Ricordeau, 44093 Nantes Cedex 1, France;2. Laboratoire des sarcomes osseux et remodelage des tissus calcifiés (Phy.OS), UMR 1238, Faculté de médecine, 1 rue Gaston Veil, 44035 Nantes Cedex, France;3. Service de pharmacie clinique, CHU de Nantes, 1 place Alexis Ricordeau, 44093 Nantes Cedex 1, France;4. Service de chirurgie Maxillo-faciale et stomatologie, CH de Saint-Nazaire, 11 boulevard Georges Charpak, 44600 Saint-Nazaire, France;5. Laboratoire d’Ingénierie Ostéo-Articulaire et Dentaire (LIOAD), Faculté de Chirurgie Dentaire, 1 Place Alexis Ricordeau, 44042 Nantes, France |
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| Abstract: | When patients attend the emergency department with facial fractures that require surgery and are immediately admitted, surgery can be delayed as theatre time is prioritised for other more urgent patients. One solution is to send the patient home and admit them as an elective patient at a later date. The aim of this study was to investigate the outcomes of patients admitted directly and those seen as elective patients following fracture of the mandible or zygomatic complex. Data were taken from the hospital episodes statistics (HES) dataset for 2011-2018, and all hospital admissions for mandibular and zygomatic complex fractures within the National Health Service (NHS) in England were extracted. Patients were categorised as those admitted on attendance at the emergency department and given definitive treatment during the admission, and those not admitted on attendance at the emergency department but discharged home and seen as elective admissions within 30 days of attendance. Data were available for 39 606 patients. For both types of fracture there was substantial variation between NHS trusts in the proportion of patients admitted electively and the proportion admitted directly as emergencies. Elective admission was independently associated with shorter overall stay and lower emergency readmission rates. We found no evidence that delays to definitive surgery through elective admission had a negative impact on emergency readmission rates. Patients admitted electively had a significantly shorter hospital stay. |
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| Keywords: | mandible fracture zygoma fracture facial fracture day-case surgery elective surgery |
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