Zweifel Daniel Fritz, Simon Christian, Hoarau Remy, Pasche Philippe, Broome Martin
Consultant, Maxillofacial Surgery Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Chief Consultant, Ear-Nose and Throat Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
J Oral Maxillofac Surg. 2015 Jan;73(1):170-5. doi: 10.1016/j.joms.2014.07.038. Epub 2014 Aug 1.
Virtual planning and guided surgery with or without prebent or milled plates are becoming more and more common for mandibular reconstruction with fibular free flaps (FFFs). Although this excellent surgical option is being used more widely, the question of the additional cost of planning and cutting-guide production has to be discussed. In capped payment systems such additional costs have to be offset by other savings if there are no special provisions for extra funding. Our study was designed to determine whether using virtual planning and guided surgery resulted in time saved during surgery and whether this time gain resulted in self-funding of such planning through the time saved.
All consecutive cases of FFF surgery were evaluated during a 2-year period. Institutional data were used to determine the price of 1 minute of operative time. The time for fibula molding, plate adaptation, and insetting was recorded.
During the defined period, we performed 20 mandibular reconstructions using FFFs, 9 with virtual planning and guided surgery and 11 freehand cases. One minute of operative time was calculated to cost US $47.50. Multiplying this number by the time saved, we found that the additional cost of virtual planning was reduced from US $5,098 to US $1,231.50 with a prebent plate and from US $6,980 to US $3,113.50 for a milled plate.
Even in capped health care systems, virtual planning and guided surgery including prebent or milled plates are financially viable.
使用或不使用预弯或铣削板进行虚拟规划和引导手术，在游离腓骨瓣（FFF）下颌骨重建中越来越普遍。尽管这种出色的手术选择正在得到更广泛的应用，但规划和切割导板制作的额外成本问题仍需探讨。在定额支付系统中，如果没有额外资金的特殊规定，此类额外成本必须通过其他节省来抵消。我们的研究旨在确定使用虚拟规划和引导手术是否能节省手术时间，以及节省的时间是否能通过节省的时间来实现此类规划的自筹资金。
在两年期间对所有连续的FFF手术病例进行评估。使用机构数据确定1分钟手术时间的价格。记录腓骨塑形、钢板适配和植入的时间。
在规定期间，我们使用FFF进行了20例下颌骨重建，其中9例采用虚拟规划和引导手术，11例为徒手手术。计算得出1分钟手术时间成本为47.50美元。将该数字乘以节省的时间，我们发现使用预弯板时，虚拟规划的额外成本从5098美元降至1231.50美元，使用铣削板时从6980美元降至3113.50美元。
即使在定额医疗保健系统中，包括预弯或铣削板的虚拟规划和引导手术在经济上也是可行的。
