The characteristics and cost of LeFort fractures: a review of 519 cases from a nationwide sample

Publication date: Available online 13 February 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Kevin C. Lee, Sung-Kiang Chuang, Sidney B. Eisig

Abstract

Purpose

The aims were to report the characteristics of LeFort fractures and to quantify the associated hospital costs.

Method

From October 2015 to December 2016, the National Inpatient Sample (NIS) was searched for patients admitted with a primary diagnosis of a LeFort fracture. Predictor variables were drawn from demographic, admission, and injury characteristics. The outcome variable was hospital cost. Summary statistics were calculated and compared among LeFort patterns. Univariate comparisons and multivariate regression analyses were conducted to determine predictors associated with cost.

Results

A total of 519 patients were identified in this cohort. Associated injuries included skull fractures (28%), intracranial hemorrhage (13%), cervical spine injury (9.8%), and concussion (9.1%). 73% of patients received open reduction and internal fixation (ORIF) for their facial fractures during their admission, 13% a tracheostomy, and 10% were mechanically ventilated for at least 1 day. The ventilation (p<0.01) and tracheostomy (p<0.01) rates increased with LeFort complexity as did the length of stay (LOS) (p<0.01), costs (p<0.01), and charges (p<0.01). The mean costs of treating LeFort I, II, and III fractures were $25,836; $28,415; and $47,333, respectively. Increased cost was independently associated with younger age, male gender, African-American ethnicity, LeFort II and III patterns, motor vehicle accident etiology, mechanical ventilation requirement, tracheostomy, ORIF, transfer to outside facility, and increased LOS.

Conclusions

The prevalence of head injuries and the need for respiratory support significantly increased with LeFort complexity. Hospital costs were not significantly influenced by the diagnosis and management of associated injuries. Instead, costs were predominantly driven by fracture complexity and the need for necessary procedures such as ORIF, tracheostomy, and mechanical ventilation.

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