Abstract
BACKGROUND: Odontogenic infections remain a frequent cause of hospitalization and can progress to systemic complications with substantial resource use. Reliable 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 to 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 regressions. 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), chronic alcohol addiction (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 multi-space involvement (aOR: 8.381; 95% CI: 4.390-16.000; p < 0.001). CONCLUSIONS: Age, COPD, chronic alcohol addiction, and multi-space involvement independently predict systemic complications in odontogenic infections. Multi-space involvement also identifies patients at risk for prolonged hospitalization. The increasing burden of odontogenic infections highlights the need for a clinical risk score to enable early risk stratification, guide triage, and improve interdisciplinary management while reducing treatment costs.