Abstract
Background
Severe cervicofacial abscesses require emergency incision and drainage under general anaesthetic to avoid life-threatening sequelae. There is a well-described association between dental disease and socioeconomic status (SES), and most cervicofacial abscesses are odontogenic.
Methods
We retrospectively reviewed the relationship between severe cervicofacial infection and SES in patients presenting to a tertiary Oral and Maxillofacial Surgery (OMFS) unit.
Results
There were 96 patients with severe cervicofacial abscess in 2019–20, increasing by 11.5 %–107 patients in 2021–22 ( t -test = −0.665, p = 0.513). Patients were disproportionately from the most deprived areas, with a majority of patients living in the three most deprived deciles in both datasets (71.9 % and 64.7 % respectively). There was no statistical difference in deprivation indices between the two time periods (X 2 = 7.44, p = 0.591). While the cohorts had high indices of deprivation, these were not significantly different to the areas served by the hospital (X 2 = 11.42, p = 0.248).
Conclusions
This dataset demonstrates a high incidence of severe cervicofacial abscess in a deprived population. This relationship is likely to reflect a number of factors including access to primary dental care, lifestyle factors including smoking, and background medical comorbidities. Further iterations of data collection and multi-centre collaboration will improve our understanding of the relationship between social deprivation and severe cervicofacial abscess.
Abbreviations:
EDP
Emergency Dental Practitioner
GA
General Anaesthetic
GDP
General Dental Practitioner
I&D
Incision and Drainage
LSOA
Lower Layer Super Output Area
QOMS
Quality Outcomes in Oral and Maxillofacial Surgery
SES
Socioeconomic status
1
Introduction
Cervicofacial abscesses are collections of pus in the potential spaces of the head and neck. Severe cervicofacial abscesses require admission and emergency incision and drainage (I&D) under general anaesthetic (GA) to avoid life-threatening sequelae including airway compromise and sepsis.
The majority of cervicofacial abscesses result from untreated dental disease, and the incidence of odontogenic abscess in the UK is increasing; Douglas and Smith demonstrated that admissions for dental abscesses more than tripled from 2000 to 2020, both in absolute numbers and adjusting for population change, with a corresponding increase in bed-days [ ]. Recent local audits carried out in Hull and Bristol support these findings [ , ]. Furthermore, there is a well-described association between dental disease and socioeconomic status (SES) [ ].
In this paper we retrospectively reviewed patients presenting to a tertiary OMFS unit over two one-year periods to determine whether there was an association between severe cervicofacial infection and SES. We classified ‘severe’ abscesses as those requiring emergency I&D under GA.
2
Material and methods
This study was carried out at the Royal London Hospital (RLH), a major trauma centre in North East London serving a population of approximately 2.5 million people. We collected data on all adult patients presenting with cervicofacial infections requiring emergency surgical management under GA over two one-year periods: between April 01, 2019 and 31/03/20, and between 01/04/21 and 31/03/22. Patients were identified from departmental handover sheets and operative records. Patient records were then reviewed systematically on the Cerner Electronic Patient Record and relevant data collected in an Excel spreadsheet.
Patients who had cervicofacial infection that was managed under LA in a dental chair, ward or A&E environment were excluded. Patients who were admitted for cervicofacial infection but improved with IV antibiotics and steroids were excluded. Patients admitted under the ENT team, for example for peritonsillar abscess, were excluded. Patients who self-discharged and were readmitted one or multiple times due to psychosocial issues were considered as a single admission. Patients who were readmitted for further I&D and/or other procedures on the emergency list were considered as developing complications.
We carried out statistical testing using SciPy, and used the python library ‘pandas’ for further data processing. The python library GeoPandas was used for data visualization. Binomial data was analysed using Chi-squared testing, and normally distributed data was analysed using Student’s t-test. The threshold for statistical significance was set at p < 0.05.
The English Indices of Deprivation 2019 ranks small areas in the UK in terms of income, employment levels, education, health, crime, barriers to housing and services, and living environment. Lower layer super output areas (LSOAs) are then ranked from 1 to 32,844, where 1 is the most deprived. These areas are organised into deciles from 1 to 10, where 1 is the most deprived 10 % and 10 is the least deprived 10 %. This can be used to compare the relative poverty of small areas of similar population. We used patient postcodes to identify their deprivation decile [ ].
3
Results
There were 96 patients in the 2019-20 dataset and 107 patients in the 2021-22 dataset. There was a slight male predominance in both datasets (54.2 % and 61.7 % respectively), and median age was 37 and 35 years respectively. Patients with severe cervicofacial abscess were disproportionately deprived, with 71.9 % of patients in the 2019-20 dataset and 64.7 % of patients in the 2021-2 dataset living in the 1st to 3rd deciles (i.e. the most deprived 30 % of the UK population, see Fig. 1 ). There was no statistical difference between the deprivation indices between the two cohorts (X 2 test value 7.44, p = 0.591).
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