Justifying the implementation of intraoperative computed tomography for midface fracture treatment in improving outcomes

• Published in: British journal of oral & maxillofacial surgery 2023-05, Vol.61 (4), p.315-319
• Main Authors: Sritharan, R., Arya, R., Abdelrahman, A., Parmar, S., Sharp, I., Breeze, J.
• Format: Article
• Language: English
• Subjects: Computed tomography; Cone-Beam; Facial Bones - injuries; Facial Bones - surgery; Fracture Fixation - methods; Fractures, Bone - surgery; Humans; Intra-operative; Orbit; Predictive Value of Tests; Retrospective Studies; Tomography Scanners, X-Ray Computed; Tomography, X-Ray Computed - methods
• ISSN: 0266-4356; 1532-1940
• DOI: 10.1016/j.bjoms.2023.03.010

Intraoperative CT scanning is the international standard for treating midface fractures as it allows intraoperative assessment of reduction and fixation. To our knowledge, no NHS hospital in the UK has this facility yet due to the financial and logistical burden of its implementation. The aim of this study was to determine if complications including the requirement for a return to theatre (RTT) could have been predicted from the post-fixation CT scan. All treated midface fractures that had presented to a regionalised major trauma centre within two years (01 January 2020 - 31 December 2021) were identified. Those developing complications including RTT were determined. All postoperative CT scans (including those without complication or RTT) were re-analysed with the clinicians blinded to the outcomes to determine the positive predictive value (PPV) and negative predictive value (NPV) of requiring RTT to alter plate position intraoperatively based on CT scan alone. In all, there were eight episodes of unplanned return to theatre, resulting in an overall RTT rate of 8/119 (6.7%). When only analysing patients treated for orbital fractures this RTT rises to 8/40 (20%). Of those eight patients who had a postoperative CT and required RTT, this could have been predicted in 7/8 (87.5%). A total of 16/44 (36.4%) patients that did not have RTT would have additionally been recommended to have the plate position altered based on CT alone. Based upon those that had a CT, the PPV of CT alone being able to predict those requiring RTT was 40.6% and the NPV 96.2%. Our results would suggest intraoperative CT would likely have prevented eight patients requiring RTT in two years and could have improved outcomes in 16 cases. In preventing RTT as well as potentially improving the outcomes of a further 16 cases in maxillofacial surgery, the purchase of an intraoperative CT scanner could yield net savings of £75534-£114990 over two years.