Douglas J Courtemanche1, Richard Barton2, Damon Li3, Graeme McNeill4, Manraj K S Heran5. 1. Clinical Professor, Division of Plastic Surgery, Department of Surgery, University of British Columbia and Vancouver General Hospital, Vancouver, British Columbia, Canada. Electronic address: douglas.courtemanche@ubc.ca. 2. Private Practice, Melbourne, Australia. 3. Resident, Division of Plastic Surgery, Department of Surgery, The Royal Melbourne Hospital, Parkville, Melbourne, Australia. 4. Consultant Radiologist and Assistant Clinical Professor, University College Dublin and St. Vincent's University Hospital, Dublin, Ireland. 5. Clinical Associate Professor, Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Abstract
PURPOSE: Prior literature has shown that routine postoperative computed tomography (CT) scans for mandibular fractures have no effect on outcomes and complications; however, past surveys have reported that most clinicians continue to order routine scans. We aimed to determine the current use of routine postoperative CT scans, evaluate what factors contribute to this practice, and identify differences in outcomes and complications among patients with either routine, indicated, or no postoperative CT scans. PATIENTS AND METHODS: We conducted a retrospective review of consecutive patients treated for a mandibular fracture at Vancouver General Hospital from January 1, 2007, to March 1, 2012. RESULTS: We included 167 patients in the study for analysis. No significant differences in outcomes or complications were found between patients who had an indicated postoperative CT scan (27%) and patients with no scans (64%). Only the treating surgeon had a statistically significant effect on whether a patient received a postoperative CT scan (P < .001), and those patients who had an indicated postoperative CT scan (9%) were more likely to have a decreased level of temporomandibular joint function (P = .002) and increased incidence of complications and secondary operations (P < .001 and P < .001, respectively). CONCLUSIONS: Routine postoperative CT scans were found to have no significant effect on outcomes and complications, and a clinician's individual practice was the most significant factor for whether a patient received a routine postoperative CT scan. Future work should aim at providing well-defined indications for postoperative imaging.
PURPOSE: Prior literature has shown that routine postoperative computed tomography (CT) scans for mandibular fractures have no effect on outcomes and complications; however, past surveys have reported that most clinicians continue to order routine scans. We aimed to determine the current use of routine postoperative CT scans, evaluate what factors contribute to this practice, and identify differences in outcomes and complications among patients with either routine, indicated, or no postoperative CT scans. PATIENTS AND METHODS: We conducted a retrospective review of consecutive patients treated for a mandibular fracture at Vancouver General Hospital from January 1, 2007, to March 1, 2012. RESULTS: We included 167 patients in the study for analysis. No significant differences in outcomes or complications were found between patients who had an indicated postoperative CT scan (27%) and patients with no scans (64%). Only the treating surgeon had a statistically significant effect on whether a patient received a postoperative CT scan (P < .001), and those patients who had an indicated postoperative CT scan (9%) were more likely to have a decreased level of temporomandibular joint function (P = .002) and increased incidence of complications and secondary operations (P < .001 and P < .001, respectively). CONCLUSIONS: Routine postoperative CT scans were found to have no significant effect on outcomes and complications, and a clinician's individual practice was the most significant factor for whether a patient received a routine postoperative CT scan. Future work should aim at providing well-defined indications for postoperative imaging.