Impact of Preoperative Anemia on Surgical Success in Medication-Related Osteonecrosis of the Jaw

BACKGROUND: Anemia-related hematologic markers and surgical outcomes for medication-related osteonecrosis of the jaw (MRONJ) are not well established. PURPOSE: To measure associations between anemia and MRONJ operative outcomes. STUDY DESIGN, SETTING, SAMPLE: This retrospective cohort study included patients who underwent operative MRONJ management at the University of Pennsylvania Department of Oral and Maxillofacial Surgery from January 2013 through October 2023. Patients were included if they had a complete blood count within 60 days prior to surgery and follow up sufficient to determine treatment response. Patients with prior head and neck radiation therapy, metastatic jaw disease, nonsurgical management, missing preoperative complete blood count, or insufficient follow up were excluded. PREDICTOR VARIABLES: Preoperative red blood cell (RBC) count and hemoglobin level. MAIN OUTCOME VARIABLES: Time to treatment failure, defined as time from surgery to first documentation of repeat surgery, persistent same-stage surgery, stage progression, or postoperative complication. Subjects without treatment failure were censored at the last follow-up. COVARIATES: Demographic covariates included age, sex, and race. Clinical covariates included baseline MRONJ stage, malignancy, osteoporosis, diabetes, smoking history, penicillin allergy, antiresorptive agent, and inciting event. ANALYSIS: Cox proportional hazards regression was used to assess associations between hematologic markers and time to treatment failure. RESULTS: The final sample included 137 subjects with a mean age of 68.9 (SD, 9.8); 93 subjects (67.9%) were female. Twenty subjects (14.6%) experienced treatment failure with a median time to treatment failure of 35.5 days (interquartile range, 16.8 to 110.3 days). Subjects with favorable outcomes had higher mean preoperative RBC counts (3.92 vs 3.48 × 10ˆ6/uL) and hemoglobin levels (12.00 vs 11.05 g/dL). In adjusted Cox models, higher RBC count (hazard ratio 0.291; 95% CI 0.129 to 0.637; P = .002) and higher hemoglobin level (hazard ratio, 0.705; 95% CI, 0.528 to 0.935; P = .02) were associated with lower risk of treatment failure independent of baseline MRONJ stage. CONCLUSIONS AND RELEVANCE: Lower preoperative RBC count and hemoglobin level were associated with more severe MRONJ at presentation and shorter time to treatment failure after surgery. Routine hematologic markers may support risk stratification before operative MRONJ management.