Declining Blowout Fracture Cases and Rising Costs in South Korea (2010-2023)

Blowout fractures are a significant component of maxillofacial trauma care, but their incidence appears to be declining in South Korea. This study aims to investigate the trends in blowout fracture cases from 2010 to 2023 and assess the implications for plastic and reconstructive surgery, as well as the financial burden on patients.

A retrospective observational study was conducted using data from the Health Insurance Review and Assessment Service in South Korea. Patients diagnosed with orbital fractures (International Classification of Diseases, 10th Revision code S02.3) between 2010 and 2023 were included. Variables such as patient demographics, National Health Insurance (NHI) payments, and patient out-of-pocket expenses in United States dollars were analyzed. Time-series forecasting was performed using the Auto-Regressive Integrated Moving Average (1,1,1) model to predict future trends.

A total of 163,146 patients were diagnosed with blowout fractures from 2010 to 2023. The number of cases decreased by 48.0%, from 18,340 in 2010 to 9534 in 2023 ( P < 0.001). Despite the decline in cases, the average NHI payment per patient increased by 135.5%, and patient out-of-pocket expenses rose by 127.5% ( P < 0.01). Strong negative correlations were found between patient numbers and per-patient costs for both NHI payments ( r = -0.933) and patient expenses ( r = -0.929). The Auto-Regressive Integrated Moving Average model forecasts suggest that case numbers may stabilize, but health care costs will continue to rise through 2028.

The declining trend in blowout fracture cases poses challenges to the sustainability of this subspecialty in plastic and reconstructive surgery. Concurrently, the increasing financial burden on patients highlights limitations in the current health care coverage. Plastic and reconstructive surgeons must adapt by diversifying skills and fostering interdisciplinary collaboration. Policy reforms are necessary to reduce the financial burden on patients and ensure equitable access to care.