Mandibular fractures - towards a national standard for "time to theatre" - national audit by the BAOMS Trauma Specialist Interest Group.
Recent studies have shown that in most patients, a delay of several days in the treatment of mandibular fractures is not associated with adverse outcomes, and this has challenged the traditional practice of recommending treatment within 24hours. Longer hospital stays cost more and lower the patients' quality of life, but we know of no standard recommendation about when these patients should be treated. Our aim therefore was to find out how many patients had reduction and fixation of a fractured mandible by the end of the next working day, with a view to developing a national standard. We invited all oral and maxillofacial surgery (OMFS) units in the UK to participate in a prospective audit over two months, and 35 agreed. Overall, 506 patients (80%) were operated on by the end of the next working day. The time to theatre varied from 1 hour 15minutes to 11 days, 20hours and 51minutes (median 22hours 7minutes). Patients admitted to units with an OMFS trauma list were more likely to be operated on by the next working day (p=0.011) as were those operated on at the weekend (p=0.019). We think that early fixation, return of function, and discharge, benefit patients most in terms of quality of life. Also, shorter hospital stays and reduced costs increase the availability of resources for elective operations. Setting a standard will improve our service and the care we deliver.
ST3 in Oral and Maxillofacial Surgery, Royal Surrey County Hospital, Egerton Road, Guildford. GU2 7XX. Electronic address: Helen.katsarelis@gmail.com.
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Katsarelis
Associate Specialist In Oral and Maxillofacial Surgery, Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire Royal Hospital, Great Western Road, Gloucester. GL1 3NN.
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Lees
Consultant Oral and Maxillofacial Surgeon, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU.
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McLeod
D006801:Humans; D007902:Length of Stay; D008337:Mandibular Fractures / Q000628:therapy*; D008485:Medical Audit; D011446:Prospective Studies; D011639:Public Opinion; D011788:Quality of Life; D013997:Time Factors
Complications; Fractured mandible; Length of stay; Quality of Life; Theatre delays