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Methods: A single-center, retrospective analysis of all adult patients from January 2014- December 2016 with a mandible fracture who underwent surgical repair was performed. Patients were identified from the Trauma Division Registry using ICD-9 and ICD-10 codes. Standard Centers for Disease Control and Prevention (CDC) definitions were used to categorize SSIs. Abx, SSI, and culture data were manually collected from the medical record. Operative service was categorized between Otolaryngology service (ES), Plastic and Reconstructive service (PS), and Oral maxillofacial service (OS). Other indications for giving Abx were identified (including sinus fractures, non-Head and Neck infections such as intraabdominal infections, urinary tract infections, and pulmonary infections). Post-operative outcomes were defined as hospital Length of Stay (LOS), intensive care unit (ICU) LOS, SSI, and operative complications (including osteomyelitis, nonunion, malocclusion, and hardware infections). Post-Abx complications included Clostridium Difficile colitis, urinary tract infections, pulmonary infections, nervous system infections, blood stream infections and multidrug resistance identified on re-admission. Difference between groups were analyzed by running ANOVA test for continuous variables and Pearson Chi-squared test for categorical variables.
Results: A total of 75 patients were included in the analysis; 33 (44.0%), 26 (34.7%), and 16 (21.3%) were managed under PS, ES, and OS, respectively. Median age was 30.0 years (IQR: 22.0 – 45.0). Median Injury Severity Score (ISS) was 4.0 (IQR: 1.0 – 9.0). There were no significant differences among baseline demographics or ISS within the three groups. Median total duration for PS: 8.5 days, IQR: 6.3 – 10.0; ES: 8.8 days, 6.8 – 10.5; and OS: 1.8 days, IQR: 0.1-7.8. There was no significant difference in hospital LOS (p=0.44), ICU LOS (p=0.53), or post-op complications (p=0.15). None of our patients had SSI or post-Abx complications. While the total inpatient duration of Abx was not significantly different among services (p=0.37), there were significant differences in outpatient duration of Abx (p=0.007) and total duration of Abx (p=0.003).
Conclusion: Outpatient duration of Abx is not associated with post-operative complications including SSI. Given that the duration varies among services, there appear to be no benefit of prolonging Abx prophylaxis. Further studies are needed to study the complications of prolonged Abx use and to explore the benefit of short course Abx in mandibular fractures.