Surgical Outcomes of Mandibular Fracture Repair in Patients With Alcohol Use Disorder

Objective: To evaluate the risks of major wound healing complications in patients with a history of alcohol use disorder. Study Design: Multicenter, retrospective cohort study from January 1, 2010 to July 31, 2025. Setting: Sixty-eight healthcare institutions in the United States. Methods: Patients included were aged 18 years or older who had a history of mandible open reduction and internal fixation (ORIF). The patients were stratified into groups based on a history of alcohol use disorder. A total of 13,742 patients were included in the study. After propensity score matching, both groups with and without alcohol use disorder had 6871 patients. All major outcomes and complications including osteomyelitis, pseudoarthrosis, wound disruption, and nonunion/malunion were evaluated at 1, 3, and 6 months after surgery. Results: Patients with a history of alcohol use disorder within 6 months before surgery had higher risks of wound disruption (RR: 1.45 [1.15-1.84]), nonunion/malunion (RR: 1.31 [1.06-1.63]), and infection (RR: 1.26 [1.09-1.45]). By 3 and 6 months, they also showed increased risk of all three of these complications. Osteomyelitis after surgery was associated with a history of alcohol use disorder (RR: 1.26 [1.01-1.57]). No patients had a significantly high rate of pseudoarthrosis after surgery. Conclusion: Patients with a history of alcohol use disorder have a higher risk of complications involved with wound and bone healing following mandible ORIF. Level of Evidence: Level 3.