Do Postoperative Surgeon Phone Calls Improve Outcomes Following Mandibular Fracture Repair?

Background: Complications of open reduction and internal fixation (ORIF) of mandibular fractures are influenced by several patient factors. A postoperative surgeon phone call could modify these factors through education and reinforcement of instructions, but its effect has not been studied.

Purpose: The purpose of this study was to measure and compare the frequencies of postoperative inflammatory complications (POICs) following ORIF of mandibular fractures in patients who did and did not receive a postoperative surgeon phone call.

Study design, setting, sample: The authors conducted an ambispective cohort study consisting of patients with mandibular fractures treated with ORIF at a large urban trauma hospital with the prospective cohort from January 1, 2021 to March 31, 2022 and a retrospective cohort from April 1, 2020 to December 31, 2020. Prisoners and patients with gunshot wounds were excluded.

Predictor variable: The primary predictor variable was the surgeon call group. After January 2021, a postoperative call was implemented 1-3 days following fracture repair to review instructions, such as nonchew diet and oral hygiene, and provide education, such as reviewing expectations. Prior to January 2021, patients were not called. This resulted in 3 categories: Not Called, Called and Answered, and No Answer.

Main outcome variables: The primary outcome variable was POICs, defined as the occurrence of exposed or infected hardware, abscess formation, recurrent swelling/pain, nonunion, osteomyelitis, or fistula formation.

Covariates: Demographic variables, injury-related variables, and treatment-related variables were also measured.

Analyses: Statistical analysis was performed using Fisher's exact and Wilcoxon rank-sum tests, as well as multivariable logistic regression. A P value was considered significant if < .05.

Results: Of the 178 patients in the study, 137 (77%) were male and the average age was 39.9 ± 12.6 years. Sixty-five patients (36.5%) were not called. Of the patients called, 79 (44.4%) answered and 34 (19.1%) did not answer. POICs occurred in 9.2% of the Not Called group and 8.9% of the Called and Answered group (P = .99). In the No Answer group, 29.4% had POICs, which was higher than the other 2 groups (P = .01).

Conclusion and relevance: A surgeon phone call was not associated with complication rates; however, patients in the No Answer group were significantly more likely to experience a POIC.