Martina Brozynski

Purpose: Psychoactive substance use is often a complicating factor in injury that requires an emergency room visit. The present study examined data recorded in the National Electronic Injury Surveillance System (NEISS) database for patients who presented to an Emergency Department (ED) and had psychoactive substance involvement, requiring management by plastic surgery. Methods: A retrospective cohort study was performed using the NEISS database, from 2019 to 2021. Data from patients aged 0 to 102 who suffered burns (46, 47, 48, 49, 51, and 73), face injuries (76), hand injuries (34, 82, and 92), and had psychoactive substance use were queried. Data regarding the specific substances involved were collected. Analysis was performed using SAS to compare the incidence of various substances and the differences in admission status with psychoactive substance use. Results: According to the NEISS estimates, in the United States, 597,916 patients visited the ED for burns, 3,671,677 for facial injuries, and 6,230,087 for hand injuries from January 2019 to December 2021. Across this population, psychoactive substance use was noted in 5605 patients with burn (0.9%), 31,198 with facial (0.8%), and 26,174 with hand (0.4%) injuries. Across all 3 injury types, the total rate of admission was 20% in the substance-use population, and 5% in the nonsubstance-use population. Conclusions: For injuries presenting to the ED that require plastic surgery management, patients with documented psychoactive substance use have higher rates of admission. Given these higher rates of admission, it is important for providers to be aware of differences in the incidences of various substances and the potential for withdrawal.

Introduction: Cannabis is the third most used recreational substance in the United States. Each year, more and more states pass legislation to legalize it for both medical and recreation use. As the prevalence of cannabis use increases, it is important to study the implications for patient care, not simply the potential interactions with wound healing, and perioperative analgesia. Facial fractures are among the most common traumatic presentations for the plastic surgeon. As such, the present study aims to characterize the operative facial fracture patterns in cannabis users. Methods: The IBM MarketScan Research Databases were queried from the years 2017 to 2021. Cohorts were identified in the inpatient dataset using International Classification for Disease, 10th Revision Procedure Coding System (ICD-10-PCS) codes for facial fracture repair procedures. The cannabis cohort was separated based on presence of ICD-10 codes pertaining to cannabis use diagnoses. The cohorts were propensity-score matched using an approximate 4:1 matching ratio. Baseline cohort demographics were reported and compared including age, gender, geographic region, employment status, insurance plan type, and fracture repair type. Multivariate regression analysis was used to determine the relationship between cannabis use and fracture repair patterns. Results: There were 104 patients in the cannabis cohort and 480 in the control cohort after propensity score matching. The cannabis group had a higher proportion of male patients (80.8%vs 69.0%, P = .016) and a lower proportion of the age range from 18 to 34 years (4.8%vs 15.8%, P = .035). Employment types were different between the 2 cohorts, with more patients in the control cohort working full time (82.3%vs 69.2%, P = .045). Cannabis users had significantly less maxillary fracture repairs (1.9%vs 19.4%, P < .001). Cannabis users also had significantly more frontal fracture repairs (1.9%vs 0.2%, P = .027) and mandibular fracture repairs (76.9%vs 63.8%, P = .010). Multivariate regression revealed that cannabis users have 1.8 times greater odds of undergoing mandibular fracture repair ( P = .020) and significantly lower odds of undergoing maxillary (OR 0.07, P = .001). Conclusion: There are significant differences in the fracture patterns for cannabis users undergoing operative management and those who do not use cannabis. While mandibular fractures were the most common fracture repair type overall, cannabis users had significantly higher odds of undergoing mandibular fracture repair. This may indicate that cannabis users are more likely to sustain injuries that require operative intervention. Further study is needed to identify the relative incidences of facial fractures among cannabis users and its implications on operative considerations.

Background: With an increase in medical litigation, fractures of the mandible are not an uncommon source of legal action. The present study sought to conduct a comprehensive analysis of mandibular fracture malpractice cases. Specifically, the aim was to focus on the reasons a suit is brought, the outcomes, and the compensatory damages of litigation. The information is valuable to physicians as it may serve to minimize the risk of malpractice suits. Methods: The Westlaw and Lexis Nexis databases were searched for jury verdicts and settlements related to mandibular fracture malpractice lawsuits. Cases that did not meet the inclusion criteria, duplicate cases, and those for which enough information was not available were excluded. The data included reasons, outcomes, and monetary outcomes of litigations, as well as defendant specialty, location, year, and plaintiff demographics. Results: A total of 55 included cases spanned between 1970 and 2019. Of these, the most common reason a suit was brought included the defendant’s failure to make the diagnosis, which was noted in 27%. In 71% of the cases, the defendant was a surgeon; with 25% of these cases involving a plastic surgeon. Cases were resolved in favor of the defendant 51% of the time. Regarding outcome, 53% had a monetary outcome of $0. Conclusions: Although a slight majority of cases (51%) resulted in an outcome favoring the defendant, significant monetary consequences against the defendant were possible in cases when the plaintiff prevailed. Since failure to diagnose was the most common reason for a plaintiff to pursue litigation, physicians should thoroughly evaluate patients with suspected mandibular fractures to avoid litigation.