Cost and Inpatient Burden of Zygomaticomaxillary Complex Fracture Management

Introduction: Facial trauma makes up a significant number of emergency room visits with morbidity costs in excess of one billion dollars each year. Few studies have evaluated economic outcomes of management and inpatient burden of facial trauma, most focusing solely on mandible and isolated midface fractures. Here, we aim to evaluate characteristics associated with increased cost and length of hospitalization of zygomaticomaxillary complex (ZMC) fracture management.

Methods: Retrospective chart review at a level 1 trauma academic medical center from 2008 to 2021 was performed. Demographics, injury mechanism, associated injuries, treatment information, and associated costs were collected. Unpaired t-tests, one-way ANOVA, and pairwise comparison tests were performed to identify the patient and fracture characteristics associated with increased cost and length of hospitalization.

Results: Our 13-year experience identified 689 ZMC fractures, which presented from 2008 to 2021. 70% were male, and 40% occurred in Caucasian patients. The mean cost was $16,872.28 and mean length of hospitalization was 5.5 days. Presentation via ambulance, presentation via transfer, work injuries, traffic injuries, daily living injuries, 4 or more fractures, and associated injuries were associated with significantly higher cost, while presentation via ambulance, presentation via transfer, traffic injuries, daily living injuries, 4 or more fractures, and associated injuries were associated with significantly longer length of hospitalization (p < 0.05).

Conclusions: This study represents one of the largest comprehensive databases of ZMC fractures and one of the first to provide a descriptive cost and inpatient burden analysis of ZMC fracture management. To improve outcomes and reduce hospital cost and inpatient burden, protocols should be implemented to address the factors that we identified as contributing to increased cost and length of hospitalization.