Kupfer Philipp, Abbott Megan M, Abramowicz Shelly, Meara John G, Padwa Bonnie L
Harvard School of Dental Medicine, Boston, MA, USA.
J Oral Maxillofac Surg. 2012 Mar;70(3):685-9. doi: 10.1016/j.joms.2011.04.020. Epub 2011 Aug 5.
There has been debate in the literature regarding the advantages of an anterior versus posterior approach to the iliac crest harvest for alveolar bone grafting (ABG) in patients with cleft lip and palate. The purpose of this study was to add a cost perspective to the discussion.
This was a retrospective microcost analysis for the perioperative period for 2 approaches to graft harvest for ABG in patients with cleft lip and palate. Patient charts and hospital and physician financial databases were searched for detailed cost data in the 30 days before and after ABG for 18 patients who underwent anterior or posterior iliac crest harvest at Children's Hospital Boston. In addition, short-term outcomes for these 18 patients were documented (duration of operation, need for physical therapy services, complications, and hospital length of stay) and compared with the larger study group at the same institution.
There was a trend toward lower overall median costs for posterior compared with anterior iliac crest harvest ($18,269 vs $21,801, respectively; P = .15). The differences in cost were seen in inpatient hospital services after the operation, including ward and physical therapy costs, which were significantly lower for the posterior versus the anterior approach. This corresponded with a shorter median length of stay (1 day vs 2 days, respectively; P = .03). There was no significant difference in operating room, recovery room, or outpatient costs. More patients undergoing posterior harvest had bilateral ABG, offsetting the decreased inpatient costs with increased physician costs.
The overall cost for ABG in patients with cleft lip and palate was not significantly different between the anterior and posterior approached to iliac crest harvest. Inpatient cost was lower in the posterior group because of a shorter length of stay.
关于唇腭裂患者牙槽骨移植（ABG）髂嵴取骨采用前路还是后路方法的优势，文献中存在争议。本研究的目的是从成本角度加入讨论。
这是一项对唇腭裂患者ABG两种取骨方法围手术期的回顾性微观成本分析。检索患者病历以及医院和医生财务数据库，以获取波士顿儿童医院18例行前路或后路髂嵴取骨患者ABG前后30天的详细成本数据。此外，记录这18例患者的短期结局（手术时长、物理治疗需求、并发症及住院时间），并与同一机构的更大研究组进行比较。
与前路髂嵴取骨相比，后路取骨的总体中位成本有降低趋势（分别为18,269美元和21,801美元；P = 0.15）。成本差异体现在术后住院服务方面，包括病房和物理治疗费用，后路方法明显低于前路方法。这与较短的中位住院时间相对应（分别为1天和2天；P = 0.03）。手术室、恢复室或门诊费用无显著差异。更多接受后路取骨的患者进行双侧ABG，抵消了住院成本的降低与医生成本增加的影响。
唇腭裂患者ABG髂嵴取骨的前路和后路方法总体成本无显著差异。后路组住院成本较低，因为住院时间较短。
