Re-audit of time to surgery for mandibular fractures following implementation of the Head and Neck Assessment Hub (HANAH)

Introduction
Recent studies have shown that delays in the treatment of mandibular fractures are not associated with adverse outcomes, and this has challenged the common practice of recommending treatment within 24 hours. However, the BAOMS Trauma Special Interest Group advocates early operation to facilitate prompt discharge. ​We aim to analyse the time from admission to operation of mandibular fractures and identify any reasons for delays.

Method
Retrospective data was collected from records of all admitted mandible fractures over a 3 month period between May and July in 2022, 2023 and 2025 from a major trauma hospital. Time from admission to operation was measured and compared to the standard that 100% of mandibular fractures will undergo open reduction and internal fixation (ORIF) within 48 hours of admission. Data collected also included: patient demographics, other injuries, theatre type, complications and discharge time.

Results
77% (10/13), 79% (15/19) and 76% (13/17) of mandible fractures underwent ORIF within 48 hours of admission over the same 3 month period in 2022, 2023 and 2025 respectively. The mean, median and range of time to undergo ORIF from admission for: 2022 was 36.5 hours, 27 hours, 11-100 hours respectively; 2023 was 40.4 hours, 19 hours, 0-282 hours respectively; 2025 was 26.7 hours, 19 hours, 5-63 hours respectively. There were 0, 4 and 6 post-operative complications over the 3 month period in 2022, 2023 and 2025 respectively.

Conclusion
The set standard was not met and the proportion of mandible fractures that underwent operation within 48 hours of admission over the years is consistently around 76-79%. Unlike previous years, 3 of the cases that underwent operation over 48 hours in 2025 had post-operative complications. We will continue to monitor to see if a dedicated trauma list would be indicated.