Predictors of systemic complications and prolonged hospitalization in odontogenic infections: a 12-year retrospective analysis of 997 cases

Background Odontogenic infections remain a frequent cause of hospitalization and can progress to systemic complications with substantial resource use. Robust risk stratification is needed to guide early management. Therefore, this study aimed to identify independent risk factors for systemic complications and prolonged hospitalization in odontogenic infections, and to examine trends in case frequency over a 12-year period. Methods A retrospective analysis of 997 surgically treated inpatient cases from 2012–2023 was conducted. Clinical outcomes of interest were systemic complications and prolonged hospitalization (≥ 10 days). Associations with clinical and demographic variables were evaluated using bivariate and multivariable logistic regression. Multivariable models were validated by bootstrap resampling and receiver operating characteristic analyses. Case volume trends were analyzed using Poisson and negative binomial regression models. Results Annual hospitalization rates for odontogenic infections increased significantly over the study period (IRR 1.043; 95% CI: 1.025–1.063; p  < 0.001), despite an overall decline in inpatient admissions. Systemic complications occurred in 3.8% of cases and were independently associated with age (aOR: 1.040 per year; 95% CI: 1.019–1.061; p  < 0.001), COPD (aOR: 3.707; 95% CI: 1.569–8.761; p  = 0.003), alcohol use disorder (aOR: 5.625; 95% CI: 2.270–13.937; p  < 0.001), and multi-space involvement (aOR: 5.492; 95% CI: 2.379–12.681; p  < 0.001). Prolonged hospitalization occurred in 6.7% and was independently predicted by age (aOR: 1.019 per year; 95% CI: 1.006–1.033; p  = 0.006) and multi-space involvement (aOR: 7.303; 95% CI: 3.887–13.720; p  < 0.0019). Conclusions Age, COPD, chronic alcohol addiction, and multi-space involvement independently predict systemic complications in odontogenic infections. Age and multi-space involvement also identify patients at risk for prolonged hospitalization. The increasing burden of odontogenic infections highlights the need for early risk assessment and structured interdisciplinary management to prevent complications and reduce treatment costs.