Impact of Delayed Surgery on Outcomes of Panfacial Fractures in Low-Resource Healthcare Settings: A Retrospective Cohort Study

Background: Panfacial fractures, involving simultaneous injuries to the upper, mid, and lower facial skeleton, pose significant challenges due to their complexity. Timely surgical intervention is critical for optimal functional and aesthetic outcomes, yet delays are common in resource-limited settings. Objective: To assess the impact of delayed surgical treatment on outcomes in patients with panfacial fractures. Methods: This retrospective cohort study reviewed 120 adults (aged 18–65 years) treated for panfacial fractures at a tertiary centre in Western India from January 2022 to June 2025. Fractures included combinations of frontal, Naso-orbito-ethmoidal, zygomatic, and mandibular injuries. Patients were grouped by surgical timing: early (≤7 days post-injury) or delayed (>7 to ≤30 days). Cases beyond 30 days were excluded to avoid secondary deformities. Outcomes evaluated included function (Oral Health Impact Profile, Functional Disability Index), aesthetics (Facial Aesthetic Index, patient satisfaction), and complications (e.g., asymmetry, chronic pain). Statistical analyses used t-tests, chi-square tests, logistic regression, and Kaplan–Meier survival analysis. Results: Among 120 patients (88% male, mean age 32 ± 10 years), 54 (45%) underwent early surgery and 66 (55%) delayed surgery, primarily due to road traffic accidents (82%). Delayed surgery was associated with worse functional outcomes (OHIP-14: 18.7 vs. 12.5; FDI: 20.1 vs. 15.3; both p<0.001), reduced aesthetic scores (FAI: 75 vs. 85; p<0.01), and higher rates of complications, including asymmetry (25% vs. 12%) and chronic pain (28% vs. 15%). Delayed surgery independently predicted adverse outcomes (OR 2.3, 95% CI 1.5–3.6). Conclusion: Surgical delays beyond 7 days significantly impair outcomes in panfacial fractures. Enhanced trauma care systems are vital to ensure timely surgery in low-resource settings.