Early outcomes and risk factors in open reduction and internal fixation of mandibular fractures in adults: a 15-Year multi-institutional analysis of 2,705 cases.
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PURPOSE: Mandibular fractures (MF) are among the most common facial injuries, with significant implications for patient function and quality of life. There is a lack of comprehensive, multi-institutional studies examining short term outcomes and predictors of early complications after treatment of mandibular fractures. METHODS: The American College of Surgeons National Surgical Quality Improvement Program database (ACS-NSQIP) was queried for the time period 2008 through 2021 to identify patients who underwent open reduction and internal fixation (ORIF) of MF. We extracted data on comorbidities, preoperative blood values, and 30-day postoperative outcomes regarding the occurrence of complications. RESULTS: A total of n = 2,705 patients (443 females; 2,262 males) with an average age of 35 years and a mean BMI of 25.4 kg/m² were analyzed. The most common fracture locations were the mandibular body (42%), angle (22%), and symphysis (16%). Complications occurred in 9.4% of cases, with reoperations and readmissions being the most common general complications. Multivariate analysis revealed site-specific risk profiles: condylar and symphyseal fractures showed higher complication rates, while subcondylar fractures had lower rates. Patients undergoing ORIF without placement in mandibulomaxillary fixation (MMF) had a higher rate of surgical complications. Smoking, weight loss, disseminated cancer history, and higher wound class were independently associated with increased risk of complications. CONCLUSION: A 30-day postoperative complication rate of nearly 10% emphasizes the need for robust risk stratification and targeted strategies to further improve surgical safety in this challenging patient population. Site-specific risk variations, particularly for symphyseal and condylar fractures, and the higher rate of complication in patients without MMF, underscore the importance of tailored procedural planning. Moreover, identifying smoking and inpatient care as independent risk factors underscores the value of addressing modifiable risks and optimizing care for high-risk patients to improve surgical outcomes.