Emergency treatment for facial injury and global surgery 2030: a single centre study

Abstract

The Lancet Commission on Global Surgery highlighted a report in 2015 to improve access to safe, affordable surgical and anaesthesia care on the global burden of diseasesrequiring surgery such as trauma. Incorporating the Sustainable Development Goals 3 as well into the background, we wish to evaluate the emergency management of facial injuries caused by road traffic accident and their complications in Universiti Kebangsaan Malaysia Medical Centre. A retrospective records review was conducted on 300 patients presented the Emergency Department, with facial injuries due to road traffic accidents between January 1, 2017, to December 31, 2021. Demographic characteristics, treatment performed in the emergency setting, duration of treatment completion, and complication related to soft tissue injury were compared using univariate analysis. Of the 300 patients who met the inclusion criteria, mean age at presentation was 34.2 (Standard deviation ±14.7) years. Half of the health personnel who first attended the patients were the dental officers (54.7%), followed by postgraduate students (44.3%), medical officers, and the paramedics. Overall facial injury treatment completion was 98.3%, and soft tissue injury treatment completion was 96.7%. The mean duration for treatment completion was 3.72 (±1.43) hours, and 93.3% of patients were treated within 6 hours of injury. Post-treatment wound complications were identified in 6.0% of patients. The following factors showed statistically significant association with wound complications in univariate analyses; 6 hours duration of treatment completion (p = 0.004), patients with diabetes mellitus (p = 0.027), wound contamination (p < 0.001), tissue loss (p = 0.003), and number of soft tissue injury sustained (p = 0.027). The multivariate analysis showed that age above 45 years old had the odds ratio (OR) of 3.18 (95% CI 1.073 – 9.446, p = 0.037) with delayed treatment completion (more than 6 hours). Duration of treatment completion more than 6 hours showed OR of 10.09 (95% CI 2.329 – 43.779); p = 0.002) and operator factor (OR 4.60 (1.228 – 17.284; p = 0.024) were important determinants in wound complication. The results suggest that prompt treatment of facial soft tissue injury and maxillofacial residents with more working experience as the operators may improve outcomes.