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Marcus J. Ko, Jonathan W. Kim, Robert Arrigo, Eleonora M. Lad; Orbital Fractures: National Inpatient Trends and Complications. Invest. Ophthalmol. Vis. Sci. 2011;52(14):725.
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To examine cost, demographics and short-term complications associated with orbital fractures and surgical repair in the inpatient population in the United States over a sixteen year period (1993-2008).
A retrospective cohort study was performed by using the Nationwide Inpatient Sample (NIS) from 1993 to 2008 and searching the database for discharges classified with ICD-9 diagnosis codes of orbital fractures, orbital fracture repair, and associated diagnoses.
There was a nearly 60% increase in the annual number of orbital fractures over this period with 13,531 admissions in 1993 and 21,745 admissions in 2008. National demographics for patients with orbital fractures included 67% male, most commonly between 18-44 years of age (43%), with 75% of cases at large teaching hospitals. Hospital length of stay remained relatively constant over this period at approximately 3.4 days. However, charges increased considerably from $8245 in 1993 to $35,048 in 2008. Associated diagnoses included eyelid laceration (5%), commotio retinae (2.9%), and globe rupture (1.7%). Approximately 41% of patients underwent orbital fracture repair. Surgical patients were younger than non-surgical patients by approximately 10 years (mean age 31 vs 41 years). An overall complication rate of 4.8% was noted including: pulmonary (2.6%), renal (0.69%), wound complication (0.44%), strabismus (0.48%). Orbital fracture repair was associated with an extra day of hospitalization and $15,000 in hospital charges. The rate of pulmonary complications, wound complications and strabismus was higher in the patients undergoing orbital fracture repair (P<0.05).
The number of orbital fractures has dramatically increased over the past decade and so has associated cost. Acute repair of orbital fractures is commonly performed and can be associated with a longer length of hospital stay, increased cost as well as higher rate of pulmonary complications, wound complications and strabismus. It is important to carefully weigh the risk/benefit profile and comorbidities in determining whether surgical intervention is recommended in orbital fracture patients.
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