Pre-operative Lab Values and Wound Healing following Facial Trauma Surgery: Which Values Predict Postoperative Complications?

Abstract

Statement of the problemCan pre-operative lab values be used to predict wound healing in maxillofacial trauma patients? Materials and methodsAn IRB-approved (#4699) retrospective cohort study of patients with maxillofacial trauma that required surgical repair from 2014 to 2020 was performed. Patients treated by OMSs at a single Level I Trauma Center (University of Tennessee Medical Center) were included in the study. The primary predictor variables were preoperative lab values, including serum albumin, WBC, ANC, and lymphocyte count. Complications related to surgical reconstruction of facial injuries represented the primary outcome variable. Methods of data analysisIndependent T-test analysis was completed to assess for significant associations between these objective measures in relation to postoperative complications. A Chi-square test was performed to assess for differences in complication rates based on patient sex. ResultsThe patient cohort included 57 individuals; of whom, 42 were men. There was no difference in complication rates between men and women (P = .47). The average age of the patients at surgery was 38 years. Of these 57 patients, 15 had complications ranging from surgical site infection to prolonged trigeminal nerve hypothesia. When controlling for all other variables, ANC:lymphocyte ratio and number of procedures were both approaching statistical significance P = .097 and .058, respectively. Subjects experiencing complications were found to have an average ANC:lymphocyte ratio of 11.645, while those who had no complications had an average ANC:lympocyte ratio of 7.759. Pre-operative albumin was not found to be statistically significant in maxillofacial trauma patients with a P = .522. Patients without complication had an average albumin of 4.011, and those with complication average an albumin level of 4.143. Outcomes dataSee attached tables. ConclusionLymphocytes are recognized as critical regulators to wound healing via modulation and regulation of growth factors and cytokines.1 Often observed, but rarely characterized, differences in preoperative lymphocyte to neutrophil ratios seem to relate a risk of complication to the patient. Additionally, recent literature has reflected an association between poor nutritional status, with albumin levels used as a surrogate marker, and postoperative complications. This correlation has been noted in oncologic procedures of the head and neck in recent years.2 The authors' study demonstrated that among those individuals meeting the inclusion criteria, there may be an association between higher ANC:lymphocyte levels and postoperative complication rates in facial trauma patients. However, there was no relation between preoperative albumin levels and complications in patients. Further research and data collection are being completed in an effort to increase the power of these results.