SP30. Surgeon Specialty and Experience Impacts Practice Patterns in Orbital Fracture Management: A National Survey

PURPOSE: Multiple surgical specialties, including ophthalmology (ophtho), plastic surgery (PS), oral and maxillofacial surgery (OMFS), and otolaryngology (ENT), all treat orbital fractures and may have unique practice patterns. There are no clear clinical guidelines to address orbital fractures. The aims of this study were to identify the differences in management of isolated orbital floor fractures by surgical specialty and surgeon experience. By determining areas of differences in management, we hope to highlight areas where clear, data-based guidelines are needed. METHODS: An anonymous survey was sent to members of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS), the American Society of Maxillofacial Surgeons (ASMS), the American Association of Oral and Maxillofacial Surgeons (AAOMS), and the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) between 2022-2023 to identify practices regarding orbital floor fractures. Data obtained included surgical specialty, training level, and number of orbital wall fractures treated annually. RESULTS: A total of 389 surgeons completed the survey. Representation from each field was achieved with 37.8% of respondents from ophthalmology, 23.1% plastic surgery, 23.4% OMFS, and 15.7% from ENT. Most providers use a combination of indications to operate on orbital floor fractures, with general agreement on clinically significant enophthalmos and orbital floor defects >50%. On specialty analysis, ophthalmologist differ significantly from others and are most likely to observe for clinically significant enophthalmos (p<0.001). Among several clinical scenarios (orbital defects <50%, orbital defects >50%, diplopia with entrapment, and diplopia without entrapment) ophthalmology was more likely to observe for longer duration as compared to other specialties (p<0.05). Training level was significantly associated with intervention timing for the scenario of diplopia with entrapment, with more senior attendings (>15 years in practice) less likely to operate immediately as compared to more junior respondents (p<0.001). The most common surgical approach was the transconjunctival preseptal approach (53%). The most common implant material used was porous polyethylene-titanium (49.6%). Most providers did not use perioperative imaging, though ophthalmology was the least likely to use imaging while ENT and OMFS were more likely to (p<0.001). The use of prophylactic and postoperative antibiotics was mixed, with over half of respondents using antibiotics in both instances. On specialty analysis, ophthalmology was more likely to avoid using antibiotics (p<0.001) as compared to others. The use of antibiotics also differed by experience, with greater experience showing less antibiotic use. CONCLUSIONS: While most providers agree regarding indications, timing of surgery, surgical approach, implant material, imaging, and antibiotic preferences, ophthalmology was the most likely to differ from the other three surgical fields. Ophthalmology was more likely to observe and delay interventions for longer, avoid imaging, and avoid antibiotics. Surgical experience, measured by training level or number of fractures treated annually, also influences surgical preferences. Future directions may include examining the surgical outcomes among different surgical subspecialties to assist with universal guideline development.