HSC Section 3 - Trauma, Critical Care and Sleep Medicine

Annals of Plastic Surgery • Volume 83, Number 1, July 2019

Sharma et al

imaging, patients who experienced a change in treatment were noted. A change in treatment was determined by (1) explicit documentation by the operating surgeon in progress notes and/or physical examination findings that future treatment would be necessary following a postoper- ative CT report and (2) indication to return to the operating room only following postoperative CT imaging. Cost data were obtained in US dollars from UC Irvine Plastic Surgery Department of Billing. Standard costs of imaging and medical management for orbital fracture repairs at UC Irvine Medical Center were extracted from the UC Irvine Medical Center Revenue Cycle for the 2017 fiscal year. The CPT codes and costs associated with proce- dures of interest for this study are shown in Table 3. Data collection and basic analysis were conducted in Microsoft Excel. A χ 2 analysis was conducted to calculate P values for nominal variables, and t test analysis was conducted to calculate P values for continuous variables. SAS/STAT (version 9.4) and MATLAB were used to perform multivariate regression models to determine whether certain variables predicted a change in clinical management. RESULTS We analyzed the demographic characteristics, components of presurgical and postsurgical management, and procedure costs of patients who did or did not experience change in medical management following postoperative imaging. A literature review was conducted to delineate what had been previously concluded regarding the efficacy of

postoperative CT scans in plastic surgery and in cases other than plastic surgery (Supplemental Table 1, http://links.lww.com/SAP/A332). 3 – 14 To our knowledge, this is the first study that has studied the association between postoperative CT scans and outcomes in repaired orbital floor fracture patients. From 2008 to 2017, 234 patients underwent orbital floor fracture repair at our institution. For the sake of analysis, 17 (7.3%) were excluded because of insufficient documentation in the patients' medical records. Of the remaining cohort of 217 patients, postoperative imaging was ordered for 83 individuals, or roughly 40% of all orbital floor fracture repair cases. Of the 83 patients who received postoperative imaging, 47 patients received a CTalone (56.6%), 25 patients received either a magnetic resonance imag- ing (MRI) and/or x-ray scan alone (30.1%), and 11 patients received a CT scan along with an MRI and/or x-ray scan (13.3%). Overall, postoperative CT findings, with or without additional imaging, influenced clinical man- agement in 6 patients, which amounts to 7.2% of the patients with postop- erative imaging and 3% of the entire patient cohort (Fig. 1). For all 6 patients, the change in medical management consisted of a return to the operating room for either revision surgery or removal of hardware. Comparatively, a decision for reoperation was made for 28 patients after relying solely on physical examination findings such as extraocular muscle restriction, persistent enophthalmos, and correction of aesthetic appearance (13% of cohort, 82% of all patients undergoing reopera- tion). Postoperative CTwas not a determining factor in the decision tree for these 28 patients.

FIGURE 1. Patient flowchart.

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