Geriatric Fall-Related Facial Fractures: A Nationwide Analysis of Epidemiology, Risk Factors, and Outcomes

INTRODUCTION: Falls are the leading cause of facial fractures in the elderly, contributing to significant morbidity and mortality. OBJECTIVES: This study aimed to identify the trends, epidemiology, characteristics, and outcomes of facial fractures in the elderly resulting from mechanical falls. METHODS: The 2018 to 2020 NEDS HCUP database was queried for facial fracture encounters using the ICD-10 codes. Demographics, causes of injury, concomitant injuries, and cost data were evaluated. Multivariable logistic regression analysis was performed to ascertain the factors associated with facial fracture from etiology and mortality. RESULTS: Of 420,105 geriatric facial fractures, 320,209 (76%) resulted from falls. Fall-related facial fractures occurred in older patients (mean age, fall: 79 y versus non-fall: 75 y, P < 0.001). Mortality was lower following falls compared with non-fall mechanisms (fall: 2.2% versus non-fall: 4.3%, P < 0.001), though falls were associated with substantial morbidity, with 43.7% requiring discharge to skilled nursing facilities and 30.6% requiring hospital admission. Increasing age, higher injury severity score, skull vault, skull base, and occipital fractures independently predicted mortality (all P < 0.001). Injury severity score ≥25 was associated with 9-fold increased odds of death (OR: 9.03, 95% CI: 7.98-10.20). CONCLUSIONS: Mechanical falls account for the majority of geriatric facial fractures and are associated with significant morbidity and mortality, particularly among older individuals with high injury severity and cranial fractures. These findings highlight the need for early risk stratification and targeted fall-prevention strategies to reduce adverse outcomes in the elderly. Findings may supplement a clinician's judgment in cases where the mechanism and severity of a patient's injuries are ill-defined.