Defining National Benchmarks for Operative Nasal Fracture Management: Perioperative Outcomes Across Nearly Two...

Nasal fractures are the most common facial fractures, yet national benchmarks for perioperative outcomes and drivers of surgical decision-making remain poorly defined. Leveraging nearly 2 decades of multi-institutional data, this study establishes contemporary standards of perioperative safety and characterizes factors influencing operative approach.

A retrospective cohort study using the ACS-NSQIP database (2007-2024) identified adult patients who underwent operative nasal fracture repair. Patients were stratified by operative approach (closed vs. open reduction). The primary outcome was any 30-day postoperative complication. Secondary analyses evaluated determinants of operative approach, sensitivity to concurrent craniofacial procedures, and specialty-based practice patterns. Multivariable logistic regression was used to identify independent predictors of operative approach.

Among 455 patients, 80.4% underwent closed and 19.6% open reduction. Across nearly 2 decades of national data, operative nasal fracture management demonstrated an exceptionally low complication rate of 1.5%, with no surgical site infections or mortality and no difference between approaches (1.4% vs. 2.2%, P=0.63). All complications represented return-to-operating-room events. Operative time (OR=1.004 per minute, P<0.001) and wound classification (OR=1.77 per class, P=0.013) independently predicted open reduction, whereas patient comorbidity was not associated with operative approach. Findings were consistent across sensitivity analyses. Specialty-based analysis demonstrated equivalent complication rates between otolaryngology and plastic surgery (1.7% vs. 1.7%, P=1.0), despite differences in operative approach selection.

This national analysis provides benchmark-level evidence that operative management of nasal fractures is uniformly safe, with negligible perioperative morbidity across practice settings. The operative approach is dictated by injury complexity rather than patient risk, thereby supporting an anatomy-driven treatment paradigm. These findings define a national reference standard for perioperative safety and provide a foundation for future outcome-driven and patient-centered studies.