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Costs and complications in mandibular reconstruction
S S Kroll1, M A Schusterman, G P Reece
1Reconstructive Plastic Surgery Section, University of Texas M. D. Anderson Cancer Center, Houston 77030.
Annals of Plastic Surgery
|October 1, 1992
Summary
Immediate bone reconstruction after mandibular resection is more cost-effective and has fewer complications than delayed reconstruction. This study compared five management strategies for patients undergoing mandibulectomy.
Area of Science:
- Oral and Maxillofacial Surgery
- Reconstructive Surgery
- Health Economics
Background:
- Rising healthcare costs necessitate evaluating the efficiency of surgical management strategies.
- Mandibular resection, often for cancer or trauma, requires complex reconstruction.
- Comparing different reconstruction methods is crucial for optimizing patient outcomes and resource allocation.
Purpose of the Study:
- To compare the combined costs and complication rates of five distinct management strategies for mandibular resection and reconstruction.
- To determine the most cost-effective and safest approach for patients requiring mandibular reconstruction.
Main Methods:
- Retrospective review of 69 patients undergoing segmental or total mandibulectomy between 1986 and 1990.
- Analysis of costs and complication rates for five reconstruction groups: soft tissue only, immediate vascularized bone, metal plate, delayed bone after plate, and delayed bone without initial reconstruction.
- Statistical comparison of average costs and complication percentages across the groups.
Main Results:
- Soft tissue reconstruction had the lowest average cost ($36,137) but a 33% complication rate.
- Immediate vascularized bone reconstruction cost $46,894 with a 50% complication rate.
- Metal plate reconstruction averaged $47,678 with a 73% complication rate.
- Delayed bone reconstruction (with or without prior plate) incurred higher costs ($52,486-$54,346) and complication rates (70%-78%).
- Bone reconstruction was more successful when performed immediately compared to delayed methods.
Conclusions:
- Immediate vascularized bone reconstruction is superior to delayed bone reconstruction in terms of cost-effectiveness and complication rates following mandibulectomy.
- While soft tissue reconstruction is cheapest, bone reconstruction offers better long-term solutions when indicated.
- Surgical teams should consider immediate bone grafting for mandibular defects to improve patient outcomes and reduce overall healthcare expenditure.