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Designing CAD/CAM Surgical Guides for Maxillary Reconstruction Using an In-house Approach
Published on: August 24, 2018
Economic Inefficiency in Maxillary Reconstruction: Patient-Specific Determinants and Implications for Reconstructive
Anne Klausing1, Ferdinand Maier2, Felix Thol2
1Senior Attending Surgeon, Clinic and Polyclinic for Oral, Maxillofacial, and Plastic Facial Surgery, University Hospital Bonn, Bonn, Germany.
Background:
Maxillary reconstruction after oncologic resection uses substantial hospital resources, but its economic efficiency within diagnosis-related group (DRG)-based reimbursement remains unclear.
Purpose:
To identify determinants of economic inefficiency after partial maxillectomy.
Study Design, Setting, Sample:
This retrospective single-center cohort study was conducted at University Hospital Bonn, Germany, and included patients undergoing partial maxillectomy for malignant tumors between 2010 and 2025. Patients with incomplete records or missing health-economic variables were excluded.
Predictor Variables:
Predictor variables were reconstructive strategy (local vs microvascular), age, sex, American Society of Anesthesiologists physical status classification, Charlson Comorbidity Index, and Functional Comorbidity Index.
Main Outcome Variable:
The primary outcome was inpatient economic efficiency, dichotomized as efficient or inefficient. Inefficiency was defined by prolonged hospitalization relative to DRG-specific length of stay targets, exceeding the DRG upper length of stay threshold, or intensive care unit/intermediate care unit utilization beyond reimbursed limits.
Covariates:
Not applicable. All analyzed variables were incorporated as predictor variables.
Analyses:
Multivariable logistic regression was used to identify predictors of inpatient economic inefficiency. Decision tree modelling and subject-level counterfactual analysis estimated individualized efficiency probabilities for both reconstructive strategies. Statistical significance was defined as P < .05.
Results:
Of 117 eligible patients, 114 (97.4%) were included after 3 exclusions with incomplete data. The sample comprised 65 females (57.0%) and 49 males (43.0%); mean age was 69.1 (SD 14.4) years. Local reconstruction was performed in 70 subjects (61.4%) and microvascular reconstruction in 44 (38.6%). Economic inefficiency occurred in 112 subjects (98.3%), and 19 (16.7%) exceeded the DRG upper length of stay threshold. Intensive care unit/intermediate care overuse occurred in 34 of 70 locally reconstructed subjects (48.6%) and 16 of 44 microvascularly reconstructed subjects (36.4%; P = .2). Subject-level modelling predicted microvascular reconstruction as the economically more efficient strategy in 84.6% of subjects.
Conclusions And Relevance:
Economic efficiency after maxillary reconstruction was associated with the interaction between patient-specific risk factors and reconstructive strategy rather than surgical complexity alone. In subject-level modelling, microvascular reconstruction was predicted to be the economically more efficient strategy in 84.6% of subjects, suggesting that assumptions regarding the inherent cost-effectiveness of local reconstruction should be reconsidered and may support more efficient resource allocation under DRG-based reimbursement.
