SA1 - Do Infectious Disease Consultations Improve Outcomes for Surgical Management of Medication-Related Osteonecrosis of the Jaw (MRONJ)?

Abstract: Infectious disease (ID) specialists are often consulted during management of medication-related osteonecrosis of the jaw (MRONJ), impacting the decision-making process for surgical interventions. The aim of this study was to evaluate the effect of ID consultations on outcomes of patients with surgically managed-MRONJ.We utilized a retrospective cohort study of patients who underwent surgical management of MRONJ (between Jan 1, 2013 and Sept 12, 2022) under oral and maxillofacial surgery service at an urban academic center. The primary predictor variable was presence versus absence of ID consultation. Primary outcome variable was the surgical outcome (improved MRONJ versus not improved MRONJ) and secondary outcome variable was continuous post-operative antibiotic duration in days. Effect of ID consultation on surgical outcome was evaluated by chi-square test, and the effect on antibiotic duration was evaluated by Mann-Whitney test. Data are presented as means (95% confidence interval). All statistical analyses were performed using GraphPad Prism (version 10.1.2), and p < 0.05 was considered statistically significant.The study included 146 patients who have been surgically managed for MRONJ, mean age in years is 68.7 (67.0-70.3), with 101 female patients (69%) and 45 male patients (31%). Forty-six patients had ID consultations and 100 patients had no ID consultations. Rates of improvement in MRONJ were similar among both patient groups (p=0.39; no ID consultation: 86.0% and ID consultation: 80.4%; Table 1). When patients did have an ID consultation, time of the consultation in relation to surgery (before, after, before and after) did not impact outcomes (p=0.08). Patients who received an ID consultation had a longer duration of post-operative antibiotics (ID consultation: 51.4 (37.1-65.8) days versus no consultation: 26.1 (22.3-29.9) days; p < 0.05). Among the patients who did have an ID consultation, time of the consultation in relation to the surgery did not impact post-operative antibiotic duration (p=0.07). The outcomes of surgically-managed MRONJ did not differ between patients who had ID consultations versus those who did not. Surgical intervention itself may have a greater impact on treatment outcomes compared to the utilization of ID consultations. Current surgical and empiric antibiotic protocols for MRONJ may be sufficiently robust, diluting the impact of ID consultations. Studies have found that surgical treatment, even in the early symptomatic stages of MRONJ, is beneficial in improving mucosal integrity, lesion downstaging, and quality of life. ID consultations may be beneficial in a subset of patients with complex disease course based on clinical and microbiologic findings. Our study contributes to the ongoing global discourse surrounding the optimization of MRONJ treatment strategies.

References: 1. Ruggiero SL, Dodson TB, Aghaloo T, Carlson ER, Ward BB, Kademani D: American Association of Oral and Maxillofacial Surgeons’ Position Paper on Medication-Related Osteonecrosis of the Jaws—2022 Update. Journal of Oral and Maxillofacial Surgery 80: 920, 2022.2. Giudice A, Barone S, Diodati F, Antonelli A, Nocini R, Cristofaro MG: Can Surgical Management Improve Resolution of Medication-Related Osteonecrosis of the Jaw at Early Stages? A Prospective Cohort Study. Journal of Oral and Maxillofacial Surgery 78: 1986, 2020.

Table 1. Effect of ID consultations on MRONJ outcomes and continuous post-operative antibiotic duration.