Francesco Mazzola1, Fiona Smithers2, Kai Cheng3, Payal Mukherjee4, Tsu-Hui Hubert Low5, Sydney Ch'ng6, Carsten E Palme7, Jonathan R Clark5. 1. Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia; IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, Genova, Italy. Electronic address: mazzola.fra@gmail.com. 2. Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia; Department of Plastic, Burns and Maxillofacial Surgery, Hutt Valley Hospital, Lower Hutt, New Zealand. 3. Institute of Academic Surgery at Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia. 4. Institute of Academic Surgery at Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia; Central Clinical School, University of Sydney, Sydney, Australia. 5. Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia; Institute of Academic Surgery at Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia; Central Clinical School, University of Sydney, Sydney, Australia. 6. Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia; Institute of Academic Surgery at Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia; Department of Plastic Surgery, Royal Prince Alfred Hospital, Sydney, Australia. 7. Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia; Central Clinical School, University of Sydney, Sydney, Australia.
Abstract
OBJECTIVES: Virtual surgical planning (VSP) uses patient-specific modelling of the facial skeleton to provide a tailored surgical plan which may increase accuracy and reduce operating time. The aim of this study was to perform a time and cost-analysis comparing patients treated with and without VSP-technology. MATERIAL AND METHODS: A retrospective analysis of 138 patients undergoing microvascular free flap mandible (76.8%) or maxillary (23.2%) reconstruction between 2010 and 2018 was performed. The cohort was divided into two groups according to reconstruction-approach: non-VSP and proprietary-VSP (P-VSP). Cost-analysis was performed comparing non-VSP and P-VSP by matching patients according to site, bone flap, indication, complexity and age. RESULTS: Fibula, scapula and iliac crest free flaps were used in 92 patients (66.7%), 33 patients (23.9%) and 13 patients (9.4%), respectively. Eight patients (5.8%) required revision of the microvascular anastomosis, of which four flaps were salvaged giving a 2.9% flap failure rate. P-VSP was associated with shorter median length of stay (LOS) (10.0 vs 13.0 days, p = 0.009), lower mean procedure time (507.38 vs 561.75 min, p = 0.042), and similar median total cost ($34939.00 vs $34653.00, p = 0.938), despite higher complexity (2.0 vs 1.0, p = 0.09). In the matched-series, P-VSP was associated with a similar median LOS (10.5 vs 11 days), lower mean procedure time (497 vs 555 min, p = 0.231), lower mean total cost ($35,493 v $37,345) but higher median total cost ($35504.50 vs $32391.50, p = 0.607), although not statistically different. CONCLUSION: VSP-technology represents a helpful surgical tool for complex reconstructions, without adversely impacting on the overall-cost of treatment.
OBJECTIVES: Virtual surgical planning (VSP) uses patient-specific modelling of the facial skeleton to provide a tailored surgical plan which may increase accuracy and reduce operating time. The aim of this study was to perform a time and cost-analysis comparing patients treated with and without VSP-technology. MATERIAL AND METHODS: A retrospective analysis of 138 patients undergoing microvascular free flap mandible (76.8%) or maxillary (23.2%) reconstruction between 2010 and 2018 was performed. The cohort was divided into two groups according to reconstruction-approach: non-VSP and proprietary-VSP (P-VSP). Cost-analysis was performed comparing non-VSP and P-VSP by matching patients according to site, bone flap, indication, complexity and age. RESULTS: Fibula, scapula and iliac crest free flaps were used in 92 patients (66.7%), 33 patients (23.9%) and 13 patients (9.4%), respectively. Eight patients (5.8%) required revision of the microvascular anastomosis, of which four flaps were salvaged giving a 2.9% flap failure rate. P-VSP was associated with shorter median length of stay (LOS) (10.0 vs 13.0 days, p = 0.009), lower mean procedure time (507.38 vs 561.75 min, p = 0.042), and similar median total cost ($34939.00 vs $34653.00, p = 0.938), despite higher complexity (2.0 vs 1.0, p = 0.09). In the matched-series, P-VSP was associated with a similar median LOS (10.5 vs 11 days), lower mean procedure time (497 vs 555 min, p = 0.231), lower mean total cost ($35,493 v $37,345) but higher median total cost ($35504.50 vs $32391.50, p = 0.607), although not statistically different. CONCLUSION: VSP-technology represents a helpful surgical tool for complex reconstructions, without adversely impacting on the overall-cost of treatment.
Authors: Chihiro Matsui; Joseph M Escandón; Arbab Mohammad; Takakuni Tanaka; Masashi Sasaki; May Me Myo; Le Yu Mon; Yi Yi Cho Thein; Hiroshi Mizuno Journal: Plast Reconstr Surg Glob Open Date: 2022-06-15
Authors: Hongyang Ma; Sohaib Shujaat; Jeroen Van Dessel; Yi Sun; Michel Bila; Jan Vranckx; Constantinus Politis; Reinhilde Jacobs Journal: Front Oncol Date: 2021-07-16 Impact factor: 6.244