Surgical site infection and patient-reported outcomes in surgically treated soft tissue facial injury: A meta-analysis

Abstract

BackgroundSoft tissue facial injuries (STFI) constitute a huge portion of craniofacial trauma but the risk of surgical site infection (SSI) and the patient-reported outcomes (PROs) following surgical management of STFI are unknown. MethodsA PRISMA-compliant search was conducted from January 1990 until March 2023, and meta-analysis was performed using R. Pooled effects of outcomes were estimated using the DerSimonian and Laird random-effects model/generalised linear mixed model, when feasible. ResultOut of 8,897 screened studies, 38 were included. Twelve studies reported PROMs (n= 985), while 28 studies reported SSI rates (n=10,996) following operative treatment for STFI. The pooled SSI rate (n=28) was 3.30% (95%CI 1.89%-5.71%). Surgical and non-surgical closure didn't differ significantly in SSI rate. PROs focused on scar outcomes, cosmetic outcomes, quality of life, and psychological impact. Subgroup analysis showed lower SSI risk in operative repair for general facial trauma compared to primary repair, and in general facial trauma compared to other aetiologies. The pooled patient scar assessment scale (PSAS), score at 6-12 months post-intervention (5 studies, n=217) was 16.16 (95%CI 15.34-16.97). Limited evidence was found regarding the effect and superiority of surgical treatment in cosmetic outcomes, quality of life and psychological impact. ConclusionOur findings emphasise the limited and unreliable evidence available concerning PROs following operative treatment for STFI. Future studies employing robust methodologies are needed to investigate optimal approaches for managing STFI.