National Economic Burden and Cost Drivers of Isolated Facial Fractures in the United States.

BACKGROUND: Facial fractures represent a common source of emergency department (ED) utilization, but the national economic burden of isolated injuries remains poorly defined. PURPOSE: The purpose was to estimate the national cost of managing isolated facial fractures and identify factors associated with expenditure. STUDY DESIGN, SETTING, SAMPLE: This was a retrospective cohort study using the 2022 Nationwide Emergency Department Sample. Adults with an isolated facial fracture based on International Classification of Diseases, tenth revision codes were included. Patients younger than 18 years were excluded. PREDICTOR VARIABLE: The predictor variable was a set of factors categorized as demogIaphic (age, sex), clinical (Charlson Comorbidity Index), care process (ED disposition, no operative intervention), and hospital-level (trauma center designation). MAIN OUTCOME VARIABLE: The primary outcome was economic burden measured as total encounter cost, derived by applying hospital-specific cost-to-charge ratios to reported charges. COVARIATES: None. ANALYSES: Survey-weighted descriptive statistics estimated national case volume and expenditure. Survey-weighted bivariate analyses and generalized linear models with log-link evaluated associations between study variables and total encounter cost. Regression coefficients were exponentiated and reported as cost ratios (CRs), representing differences in expected cost compared to the reference group. CRs greater than 1.00 indicated higher expected cost, whereas CRs less than 1.00 indicated lower expected cost. Statistical significance was defined as P < .001. RESULTS: There were 135,763 weighted ED encounters involving subjects with a mean age of 48.6 ± 21.9 years and 77,360 (57.0%) were male. The mean and median cost per encounter were $2,065 ± 3,915 and $1,151 [interquartile range, $690 to $1,941], respectively. Total national cost in 2022 was $280.3 million. In the fully adjusted multivariable model, higher expected total encounter cost was associated with hospital admission (CR, 3.26; 95% CI, 3.00 to 3.55), level I trauma centers (CR, 1.86; 95% CI, 1.63 to 2.12), operative intervention (CR, 1.75; 95% CI, 1.57 to 1.95), and mandible fractures (CR, 1.52; 95% CI, 1.37 to 1.69) (all P < .001). Encounters resulting in admission represented 6.14% of encounters but accounted for 31.9% of total national expenditures. CONCLUSIONS AND RELEVANCE: Isolated facial fractures impose substantial annual costs in the United States. Expenditures were largely driven by injury pattern and downstream care processes, particularly hospital admission.