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Perineal reconstruction after radical pelvic surgery: A cost-effectiveness analysis
Vishnu Prasath1, Alexandra I Naides1, Joseph S Weisberger2
1Rutgers New Jersey Medical School, Newark, NJ.
Surgery
|November 23, 2022
Summary
The gluteal thigh flap is the most cost-effective option for pelvic reconstruction, offering the best quality of life. Further studies are needed to compare its outcomes against other reconstructive methods.
Area of Science:
- Reconstructive surgery
- Surgical oncology
- Health economics
Background:
- Radical resection of pelvic and low rectal malignancies presents complex reconstructive challenges.
- Current literature lacks consensus on optimal reconstructive techniques for pelvic defects.
- Various methods exist, including primary closure and multiple flap options.
Purpose of the Study:
- To determine the costs and quality-of-life outcomes of different pelvic reconstruction methods.
- To identify an optimal reconstructive algorithm for pelvic defects.
- To compare primary closure, vertical rectus abdominus muscle flap, gluteal thigh flap, and gracilis flap.
Main Methods:
- Decision tree analysis was employed to evaluate cost, complications, and quality-of-life.
- Costs were based on Medicare reimbursement rates (FY2021).
- Quality-adjusted life-years were sourced from existing literature.
Main Results:
- The gluteal thigh flap emerged as the most cost-effective strategy ($62,078.28; 6.54 quality-adjusted life-years).
- Sensitivity analysis consistently favored the gluteal thigh flap.
- The gracilis flap became more cost-effective only if gluteal thigh flap complication rates were significantly higher.
Conclusions:
- The gluteal thigh flap is recommended as a first-line option for pelvic defect reconstruction due to its cost-effectiveness and quality-of-life benefits.
- Further comparative studies are necessary to definitively establish the superiority of the gluteal thigh flap over vertical rectus abdominus muscle and gracilis flaps.
