Does Preoperative Surgical Delay Lead to Increased Postsurgical Length of Stay or Reoperation in Patients With Severe Odontogenic Infections?

Abstract

While severe odontogenic infections can be life-threatening and emergent surgery can be required more often, surgical management in the operating room (OR) is completed as soon as feasible. However, provider schedules and OR availability can occasionally lead to longer delays before surgery, but their effect on outcomes is unknown. The purpose of this study was to determine the association of preoperative surgical delay with postsurgical length of stay (LOS) and reoperation in patients with severe odontogenic infections. The authors conducted a retrospective cohort study consisting of all adult patients treated in the OR with incision and drainage for odontogenic infections from 1/1/2015 to 7/30/2021 at a large, urban academic hospital. The primary predictor variable was the length of presurgical delay-the number of hours between arrival in the emergency department and the start of surgery. The primary outcome variable was the postsurgical LOS and the secondary outcome variable was the rate of reoperation. Demographics, medical history, exam findings, diagnosis, and treatment-related variables were also analyzed. Descriptive and bivariate analyses were performed along with multivariable linear and logistic regression. A P value of ≥ .05 was considered significant. There were 401 patients included in the study with 50.9% men and a mean age of 39.1years. Increased length of presurgical delay (hours) was associated with a decreased postsurgical LOS (β=-0.05days, P=.01) and length of presurgical delay was not associated with reoperation (P=.51) in the unadjusted analyses. However, length of presurgical delay was not found to be associated with either LOS (β=-0.02, 95% confidence interval (CI) -0.05 to 0.01, P=.12) or reoperation (adjusted odds ratio (aOR) 1.0, 95% CI 0.96 to 1.02, P=.67) in the adjusted analyses. The association of decreased length of presurgical delay with increased postsurgical LOS in the unadjusted analysis could reflect the practice of rapid intervention for the most ill patients. After adjusting for number of spaces, a primary indicator of infection severity, length of presurgical delay was not associated with either LOS or return to the operating room.