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Do infectious disease consultations improve outcomes of surgical management of MRONJ?
Srighana Nadella1, Marcos Moscoso Hartmann1, Puhan He2
1School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Objectives:
The aim of this study is to evaluate the effect of infectious disease (ID) consultations on outcomes of patients with surgically managed medication-related osteonecrosis of the jaw (MRONJ).
Study Design:
We utilized a retrospective cohort study of patients managed surgically for MRONJ at an academic center. The primary predictor was presence vs absence of ID consult. The primary outcome was the surgical outcome, and the secondary outcomes were length of hospital stay and continuous postoperative antibiotic duration in days. Descriptive and multivariate statistics were computed.
Results:
The study included 146 surgically managed patients with MRONJ (mean age = 68.7 years), with 101 women (69%). Rates of improvement in MRONJ were similar among both groups (no ID consult = 86.0% and ID consult = 80.4%, P = .39). ID consult was associated with a greater length of hospital stay (ID consult = 3.17 days [1.95-4.40 days]) vs no consult = 1.25 days [0.895-1.61 days], P < .05) and longer duration of postoperative antibiotics (ID consult = 51.4 days [37.1-65.8 days] vs no consult = 26.1 days [22.3-29.9 days], P < .05).
Conclusions:
The outcomes of surgically managed MRONJ did not differ between patients who had ID consultations vs those who did not. In a subset of patients with a complex disease course based on the clinical and microbiologic findings, ID consultations may be beneficial.
Insights
Infectious disease consultations did not significantly alter surgical outcomes for medication-related osteonecrosis of the jaw (MRONJ). However, ID consults were linked to longer hospital stays and antibiotic use in MRONJ patients.
Area of Science:
- Oral and Maxillofacial Surgery
- Infectious Diseases
- Pharmacology
Background:
- Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication of antiresorptive or antiangiogenic medications.
- Surgical management is often required for advanced MRONJ cases.
- The role of infectious disease (ID) consultations in optimizing surgical outcomes for MRONJ remains unclear.
Purpose of the Study:
- To evaluate the impact of infectious disease (ID) consultations on the surgical outcomes of patients with medication-related osteonecrosis of the jaw (MRONJ).
Main Methods:
- Retrospective cohort study of 146 surgically managed MRONJ patients.
- Primary predictor: presence versus absence of an ID consultation.
- Outcomes assessed: surgical improvement, hospital stay duration, and postoperative antibiotic duration.
Main Results:
- No significant difference in MRONJ improvement rates between groups (86.0% without ID consult vs. 80.4% with ID consult, P = .39).
- ID consultations were associated with significantly longer hospital stays (3.17 vs. 1.25 days, P < .05).
- ID consultations correlated with longer postoperative antibiotic durations (51.4 vs. 26.1 days, P < .05).
Conclusions:
- Surgical outcomes for MRONJ did not differ based on ID consultation status.
- ID consultations may offer benefits for a subset of MRONJ patients with complex clinical and microbiologic profiles.
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