title: Barriers to Repair in Maxillofacial Trauma.
abstract: OBJECTIVE
  Multiple factors can be associated with the delayed repair of maxillofacial injuries that may be associated with increased morbidity.
  
  
  OBJECTIVE
  To assess factors affecting timing of repair and barriers which may exist in the management of maxillofacial trauma.
  
  
  METHODS
  This retrospective cohort study at a tertiary care facility used the Current Procedural Terminology coding to identify adult patients undergoing operative repair of maxillofacial injuries between January 2010 and December 2013. Demographic information, presence and severity of concomitant injuries, as well as fracture-specific data including fracture type(s), mechanism of injury, and documented complications were recorded. Identifiable delays for medical, logistical, or other reasons were also documented. Multivariate regression modeling was used to determine factors associated with increased time to repair. A comparative analysis was used to identify association between complications and time to operative repair.
  
  
  METHODS
  Time to operative repair from date of presentation; association of known operative delay and perioperative complications.
  
  
  RESULTS
  Overall, 780 patients were included in the study. Of patients meeting inclusion criteria, mean (SD) age was 36.7 (14.2) years (range, 18-88 years), and 616 patients (79%) were male. Average time to repair was 6.5 days (range, 0-43 days), and 138 patients (17.7%) were observed to have a documented reason for delay for medical reasons (n = 62 [44.9%]), operating room logistical factors (n = 17 [12.3%]), or other reasons (n = 59 patients [42.8%]) either as a function of delayed patient presentation or failure of patients to make scheduled appointments or operations. Injury severity score (ρ = 0.45; P < .001), concurrent injuries (P < .001), decreased Glasgow Coma Scale (P < .001) and inpatient status at time of surgery (P < .001), were associated with increased time to repair. The observed complication rate was 13.6%. There was no statistically significant association between known operative delay and development of complications (χ21 = 2.92; P = .08).
  
  
  CONCLUSIONS
  Management of maxillofacial trauma appears to occur in a timely manner. Patient injury severity appears to have the greatest effect on timing of repair. While delays in operative repair may be unavoidable in certain circumstances, streamlining and managing causes of known delay may help improve and expedite patient care.
  
  
  METHODS
  3.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, University of Kentucky College of Medicine, Lexington.
authors.forename: J Paul
authors.initials: JP
authors.lastname: Radabaugh
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, University of Kentucky College of Medicine, Lexington.
authors.forename: Paul
authors.initials: P
authors.lastname: Zhang
authors.affiliation: Division of Plastic Surgery, Department of Surgery, University of Kentucky College of Medicine, Kentucky Clinic, Lexington.
authors.forename: Duane
authors.initials: D
authors.lastname: Wang
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Kentucky College of Dentistry Lexington.
authors.forename: Philip L Y
authors.initials: PL
authors.lastname: Lin
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Kentucky College of Dentistry Lexington.
authors.forename: Jared
authors.initials: J
authors.lastname: Shelton
authors.affiliation: Division of Plastic Surgery, Department of Surgery, University of Kentucky College of Medicine, Kentucky Clinic, Lexington.
authors.forename: James Y
authors.initials: JY
authors.lastname: Liau
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Kentucky College of Dentistry Lexington.
authors.forename: Larry L
authors.initials: LL
authors.lastname: Cunningham
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, University of Kentucky College of Medicine, Lexington.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Gal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008446:Maxillofacial Injuries / Q000601:surgery*; D008875:Middle Aged; D009104:Multiple Trauma / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D055815:Young Adult