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Supplemental Tables

Supplemental Table 1. Current Procedural Codes for Facial Fractures

CPT Codes Procedure

21310–21337 Nasal Bone Fractures

21338–21340 Nasoethmoid Fractures

21343–21344 Frontal Sinus Fractures

21345–21348 LeFort II Fractures

21355–21366 Malar/Zygoma Fractures

21385–21408 Orbital Fractures

21421–21423 LeFort I Fractures

21431–21436 LeFort III Fractures

21440–21470 Alveolar Ridge/Mandibular Fractures

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Supplemental Table 2. Incidence of Fracture Types^A

SFR (n=4,021) MFR (n=718)

Fracture Type Location Number (%) Fracture Type Location Number (%) Alveolar/

Mandibular L 1,825 (45.4%) Orbital, Malar/Zygoma M 230 (32.0%)

Frontal Sinus U 82 (2.0%) Orbital, Nasal M 75 (10.4%)

Le Fort I M 85 (2.1%) Nasal, Malar/Zygoma M 46 (6.4%)

Le Fort II M 27 (0.7%) Orbital, Le Fort I M 31 (4.3%)

Le Fort III M 26 (0.6%) Malar/Zygoma,

Alveolar/Mandibular ML 27 (3.8%)

Nasal M 0 (0.0%) Orbital, Le Fort I,

Malar/Zygoma M 25 (3.5%)

Nasoethmoid M 0 (0.0%) Le Fort I, Malar/Zygoma M 25 (3.5%)

Malar/Zygoma M 1,055 (26.2%) Nasal,

Alveolar/Mandibular ML 21 (2.9%) Orbital M 921 (22.9%) Orbital, Nasal,

Nasal, Le Fort II M 18 (2.5%)

MFR (n=718) Orbital, Frontal Sinus UM 14 (1.9%)

Number of Fracture Sites

Number (%) Le Fort I,

Alveolar/Mandibular ML 12 (1.7%)

2 562 (78.3%) Orbital, Le Fort II,

3 124 (17.3%)

Frontal Sinus, Malar/Zygoma,

Alveolar/Mandibular UML 1 (0.1%)

4 30 (4.2%) Other M M 97 (13.5%)

5 1 (0.1%) Other ML ML 43 (6.0%)

6 1 (0.1%) Other UM UM 23 (3.2%)

AFracture type and location for complex fracture repair (CFR) and single fracture repair (SFR). L

= Lower face. M = Middle face. U = Upper face.

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Supplemental Table 3. Incidence of Single Fracture Types within MFR^A

Fracture Type ML (n=103) UM (n=37) M (n=577) UML (n=1) Total (n=718) Alveolar/

Mandibular 103 (100.0%) N/A N/A 1 (100.0%) 104 (14.5%) Frontal Sinus N/A 37 (100.0%) N/A 1 (100.0%) 38 (5.3%)

LeFort I 26 (25.2%) 3 (8.1%) 128 (22.2%) 0 (0.0%) 157 (21.9%) LeFort II 4 (3.9%) 2 (5.4%) 70 (12.1%) 0 (0.0%) 76 (10.6%) LeFort III 5 (4.9%) 0 (0.0%) 19 (3.3%) 0 (0.0%) 24 (3.3%) Malar/zygoma 49 (47.6%) 6 (16.2%) 386 (66.9%) 1 (100.0%) 442 (61.6%)

Nasal 32 (31.1%) 13 (35.1%) 201 (34.8%) 0 (0.0%) 246 (34.3%) Nasoethmoid 5 (4.9%) 6 (16.2%) 35 (6.1%) 0 (0.0%) 46 (6.4%)

Orbital 27 (26.2%) 22 (59.5%) 445 (77.1%) 0 (0.0%) 494 (68.8%)

AMFR = Multiple fracture repair. M = Mid-face only facial fracture repair. L = Lower facial fracture repair. U = Upper facial fracture repair.

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Supplemental Table 4. Demographic Information Comparing SFR and MFR of The Mid-Face SFR (M)

Total = 2,001

MFR (M)

Total = 542 p-value Age

18-40 41-50 51-60 61-70 71-80 81-89

1,073 (53.6%) 329 (16.4%) 293 (14.6%) 155 (7.7%) 112 (5.6%) 39 (1.9%)

298 (55.0%) 83 (15.3%) 95 (17.5%) 37 (6.8%) 24 (4.4%) 5 (0.9%)

0.238*

Gender Male Female

1,405 (70.2%) 596 (29.8%)

422 (77.9%) 120 (22.1%)

<0.001 BMI

Underweight (≤18.5) Normal (18.51-24.99) Overweight (25-29.99) Obese (≥30)

52 (2.6%) 803 (40.1%) 696 (34.8%) 450 (22.5%)

14 (2.6%) 262 (48.3%) 168 (31.0%) 98 (18.1%)

0.006

Race

White

Black/African American Other

Unknown or Not Reported

1,183 (73.1%) 338 (20.9%)

98 (6.1%) 382 (---%)

385 (80.7%) 68 (14.3%)

24 (5.0%) 65 (---%)

0.003

Surgical Specialty

Otolaryngology (ENT) Plastic and Reconstructive Surgery (PRS)

Other

1072 (54.7%) 886 (45.3%)

43 (---%)

241 (45.0%) 295 (55.0%)

6 (---%)

<0.001

Functional Health Status Before Surgery

Independent Partially/Totally Dependent

1983 (99.1%)

18 (0.9%) 532 (98.2%) 10 (1.8%)

0.100*

ASA Classification Class 1 Class 2 Class 3 Class 4

519 (25.9%) 1094 (54.7%)

363 (18.1%) 25 (1.2%)

111 (20.5%) 332 (61.3%) 94 (17.3%)

5 (0.9%)

0.029*

Open Wound No Yes

1,964 (98.2%) 37 (1.8%)

523 (96.5%) 19 (3.5%)

0.020 Wound Classification

Clean

Clean-Contaminated/

Dirty/Infected

1,117 (55.8%) 884 (44.2%)

200 (36.9%) 342 (63.1%)

<0.001

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Elective Surgery No

Yes

306 (16.5%) 1,543 (83.5%)

152 (---%)

55 (11.0%) 446 (89.0%)

41 (---%)

0.002

Emergency Case No

Yes 1,909 (95.4%)

92 (4.6%) 528 (97.4%) 14 (2.6%)

0.037 Days from Admission to

Surgery 0 Days 1 Day 2 Days

3 or More Days

1,854 (92.7%) 62 (3.1%) 33 (1.6%) 52 (2.6%)

507 (93.5%) 9 (1.7%) 9 (1.7%) 17 (3.1%)

0.284*

Pre-Operative Comorbidities Smoker

Diabetes Mellitus Dyspnea

Ventilator-Dependent Severe COPD

Ascites

Congestive Heart Failure

Hypertension Requiring Medication

On Dialysis

Acute Renal Failure Disseminated Cancer Steroid Use for Chronic Condition

>10% Loss in Body Weight in Prior 6 months

Bleeding Disorder Transfusion Pre-Op Sepsis

752 (37.6%) 108 (5.4%)

28 (1.4%) 2 (0.1%) 39 (1.9%)

0 (0.0%) 10 (0.5%) 371 (18.5%)

4 (0.2%) 1 (0.0%) 7 (0.3%) 21 (1.0%)

6 (0.3%) 17 (0.8%)

4 (0.2%) 16 (0.8%)

230 (42.4%) 18 (3.3%)

8 (1.5%) 1 (0.2%) 9 (1.7%) 0 (0.0%) 2 (0.4%) 94 (17.3%)

0 (0.0%) 0 (0.0%) 0 (0.0%) 9 (1.7%) 1 (0.2%) 8 (1.5%) 1 (0.2%) 8 (1.5%)

0.039 0.048 0.839*

0.513*

0.859*

N/A 1.000*

0.522 0.584*

1.000*

0.357*

0.261*

1.000*

0.217*

1.000*

0.206*

*Fisher’s Exact Test

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Supplemental Table 5. Post-Operative Outcomes Analysis Comparing SFR and MFR of The Mid- Face

SFR (M)

n=2,001 MFR (M)

n=542 p-value

Total Operation Time 85.70±71.38 149.71±104.20 <0.001 Days from Operation to

Discharge 0 Days 1 Day 2 Days

≥3 Days

1,287 (64.3%) 566 (28.3%)

81 (4.0%) 67 (3.3%)

237 (43.7%) 207 (38.2%) 54 (10.0%)

44 (8.1%)

<0.001

≥30-Day Stay Post-Op 2 (0.1%) 0 (0.0%) 1.000*

30-Day Return to OR 39 (1.9%) 11 (2.0%) 0.905

Any Readmission^ 34/1,688 (2.0%) 11/467 (2.4%) 0.648

Death within 30 Days 3 (0.1%) 0 (0.0%) 1.000*

Any Complication

Any Complication without Transfusion as a complication

29 (1.4%) 25 (1.2%)

16 (3.0%) 10 (1.8%)

0.019 0.299*

Surgical Complications Superficial SSI Deep Incisional SSI Organ Space SSI Wound Dehiscence/

Disruption

Transfusion Intra/Post Op (e.g. due to severe bleeding) Surgical Complication without Transfusion as a complication

20 (1.0%) 13 (0.6%) 1 (0.0%) 1 (0.0%) 2 (0.1%) 5 (0.2%) 16 (0.8%)

13 (2.4%) 1 (0.2%) 3 (0.6%) 2 (0.4%) 0 (0.0%) 7 (1.3%) 6 (1.1%)

0.011 0.325*

0.032*

0.117*

1.000*

0.006*

0.443*

Medical Complication^A Pneumonia

Unplanned Intubations Urinary Tract Infection DVT/Thrombophlebitis Pulmonary Embolism On Ventilator >48 Hours Sepsis

10 (0.5%) 3 (0.1%) 2 (0.1%) 2 (0.1%) 2 (0.1%) 3 (0.1%) 1 (0.0%) 1 (0.0%)

4 (0.7%) 1 (0.2%) 1 (0.2%) 1 (0.2%) 0 (0.0%) 0 (0.0%) 1 (0.2%) 1 (0.2%)

0.514*

1.000*

0.513*

1.000*

0.381*

^Reporting began in 2011, thus cases are missing.

ANo instances of CVA/Stroke, Cardiac Arrest requiring CPR, Myocardial Infarction, septic shock, progressive renal failure, or acute renal failure seen, and thus not shown.

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Supplemental Table 6. Demographic Information Comparing Single-Aspect (mid-face only) and Panfacial (middle and lower) MFR

Single-Aspect MFR

(Mid-Face) n=542 Panfacial MFR (Mid-

Lower Face) n=100 p-value Age

18-40 41-50 51-60 61-70 71-80 81-89

298 (55.0%) 83 (15.3%) 95 (17.5%) 37 (6.8%) 24 (4.4%) 5 (0.9%)

61 (61.0%) 14 (14.0%) 13 (13.0%) 8 (8.0%) 4 (4.0%) 0 (0.0%)

0.823*

Gender Male Female

422 (77.9%) 120 (22.1%)

84 (84.0%) 16 (16.0%)

0.167 BMI

Underweight (≤18.5) Normal (18.51-24.99) Overweight (25-29.99) Obese (≥30)

14 (2.6%) 262 (48.3%) 168 (31.0%) 98 (18.1%)

6 (6.0%) 57 (57.0%) 24 (24.0%) 13 (13.0%)

0.070*

Race

White

Black/African American Other

385 (80.7%) 68 (14.3%)

24 (5.0%) 65 (---%)

53 (76.8%) 14 (20.3%) 2 (2.9%) 31 (---%)

0.338*

Surgical Specialty

Otolaryngology (ENT) Plastic and Reconstructive Surgery (PRS)

Other

241 (45.0%) 295 (55.0%)

6 (---%)

45 (47.5%) 50 (52.6%) 5 (---%)

0.664

Functional Health Status Before Surgery

Independent Partially/Totally Dependent

532 (98.2%) 10 (1.8%)

99 (99.0%) 1 (1.0%)

1.000*

ASA Classification Class 1 Class 2 Class 3 Class 4

111 (20.5%) 332 (61.3%) 94 (17.3%)

5 (0.9%)

23 (23.0%) 52 (52.0%) 24 (24.0%) 1 (1.0%)

0.252*

Open Wound No Yes

523 (96.5%) 19 (3.5%)

94 (94.0%) 6 (6.0%)

0.257*

Wound Classification Clean

Clean-Contaminated/

200 (36.9%) 342 (63.1%)

14 (14.0%) 86 (86.0%)

<0.001

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Dirty/Infected Elective Surgery

No Yes

55 (11.0%) 446 (89.0%)

51 (---%)

25 (26.3%) 70 (73.7%) 5 (---%)

<0.001

Emergency Case No

Yes 528 (97.4%)

14 (2.6%) 89 (89.0%)

11 (11.0%)

<0.001 Days from Admission to

Surgery 0 Days 1 Day 2 Days

3 or More Days

507 (93.5%) 9 (1.7%) 9 (1.6%) 17 (3.1%)

82 (82.0%) 9 (9.0%) 5 (5.0%) 4 (4.0%)

<0.001*

Pre-Operative Comorbidities Smoker

Diabetes Mellitus Dyspnea

Ventilator-Dependent Severe COPD

Ascites

Congestive Heart Failure

Hypertension Requiring Medication

On Dialysis

Acute Renal Failure Disseminated Cancer Steroid Use for Chronic Condition

>10% Loss in Body Weight in Prior 6 months

Bleeding Disorder Transfusion Pre-Op Sepsis

230 (42.4%) 18 (3.3%)

8 (1.5%) 1 (0.2%) 9 (1.7%) 0 (0.0%) 2 (0.4%) 94 (17.3%)

0 (0.0%) 0 (0.0%) 0 (0.0%) 9 (1.7%) 1 (0.2%) 8 (1.5%) 1 (0.2%) 8 (1.5%)

45 (45.0%) 8 (8.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 20 (20.0%)

0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 1 (0.0%) 5 (5.0%)

0.634 0.047*

0.617*

1.000*

0.368*

N/A 1.000*

0.523 N/A N/A N/A 0.368*

1.000*

0.617*

0.287*

0.038*

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Supplemental Table 7. Post-Operative Outcomes Analysis Comparing Single-Aspect (mid-face only) and Panfacial (middle and lower) MFR

Single-Aspect MFR

(M) n=542 Panfacial MFR

(ML) n=100 p-value

Total Operation Time 149.71±104.2 194.8±131.6 0.002

Days from Operation to Discharge

0 Days 1 Day 2 Days

≥3 Days

237 (43.7%) 207 (38.2%) 54 (10.0%)

44 (8.1%)

30 (30.0%) 42 (42.0%) 7 (7.0%) 21 (21.0%)

0.001*

≥30-Day Stay Post-Op 0 (0.0%) 0 (0.0%) N/A

30-Day Return to OR 11 (2.0%) 4 (4.0%) 0.270*

Any Readmission^ 11/467 (2.4%) 2/86 (2.3%) 1.000*

Death within 30 Days 0 (0.0%) 0 (0.0%) N/A

Any Complication

Any Complication without Transfusion as a complication

16 (3.0%) 10 (1.8%)

7 (7.0%) 5 (5.0%)

0.071*

0.068*

Surgical Complications Superficial SSI Deep Incisional SSI Organ Space SSI Wound Dehiscence/

Disruption

Transfusion Intra/Post Op (e.g. due to severe bleeding) Surgical Complication without Transfusion as a complication

13 (2.4%) 1 (0.2%) 3 (0.6%) 2 (0.4%) 0 (0.0%) 7 (1.3%) 6 (1.1%)

7 (7.0%) 3 (3.0%) 0 (0.0%) 0 (0.0%) 2 (2.0%) 2 (2.0%) 5 (5.0%)

0.025*

0.013*

1.000*

0.024*

0.637*

0.018*

Medical Complication^A Pneumonia

Unplanned Intubations Urinary Tract Infection On Ventilator >48 Hours Sepsis

4 (0.7%) 1 (0.2%) 1 (0.2%) 1 (0.2%) 1 (0.2%) 1 (0.2%)

0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%)

1.000*

^ Reporting began in 2011, thus cases are missing.

ANo instances of DVT/Thrombophlebitis, pulmonary embolism, CVA/Stroke, Cardiac Arrest requiring CPR, Myocardial Infarction, septic shock, progressive renal failure, or acute renal failure seen, and thus not shown.