Purpose

Orbital cellulitis represents a common cause of hospitalization and may require surgical intervention in selected cases. Decisions regarding operative management are often based on a combination of clinical findings, imaging, and response to antibiotic therapy.however, large-scale data identifying predictors of surgical intervention remain limited.

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Methods

A retrospective cohort analysis was performed on all patients diagnosed with orbital cellulitis between 2016 and 2020. Data was extracted for the American National Inpatient Sample (NIS). Patients were categorized into conservative and surgical management groups. Demographics, pathogen profiles, comorbidities, and clinical outcomes were compared using chi-square tests for categorical variables and t-tests for continuous variables, with statistical significance set at p<0.05.

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Results

A total of 5,377 patients were included, of whom 4,850(90.2%) were treated conservatively, and 527(9.8%) required surgical intervention. The cohort was composed of 12.1% pediatric patients age <9 years, 20.7% adolescents aged 10–18 years(20.7%), and 67.2% adults. Overall mean age was 36.8 years; surgical patients were younger on average than nonsurgical patients in the adult population. Microbiologically, MSSA was significantly more prevalent in surgical patients in both pediatric(9.4% vs 2.4%) and adults(7.4% vs 2.8%, p<0.001). MRSA demonstrated a strong association with surgery in adults.Chronic sinusitis(31.3% vs 17.6%, p<0.001), acute sinusitis(39.8% vs 19.0%, p<0.001) were strongly associated with surgical intervention. Surgical rates declined significantly from 16.3% in 2016 to 6.5% in 2021(p<0.001).

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Conclusion

Surgical intervention in orbital cellulitis is associated with specific microbiological profiles, sinus-related comorbidities, and male gender, particularly in adults. The significant reduction in surgical rates over time suggests evolving management strategies and improved non-operative care. Early identification of high-risk patients may assist in optimizing treatment decisions and resource utilization.

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Additional Authors

First name	Last name	Base Hospital / Institution
Dr. Norma	Espinoza	Hillel Yaffe Medical Center
Dr. Karin	Gutzeit	Hillel Yaffe Medical Center
Dr. Yara	Karawani	Hillel Yaffe Medical Center
Dr. Shay	Keren	Hillel Yaffe Medical Center

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