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综合征性颅缝早闭中的Le Fort III型:牵张成骨与单阶段内固定技术的成本比较

Le Fort III in Syndromic Craniosynostosis: Cost Comparison of Distraction Osteogenesis Versus Single-Stage Internal Fixation Techniques.

作者信息

Mosa Adam J, Zellner Elizabeth, Ho Emily S, Fisher Mark D, Phillips John H, Forrest Christopher R

机构信息

Center for Craniofacial Care and Research, The Hospital for Sick Children, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Canada.

Division of Plastic Surgery, Westchester Medical Center and Maria Fareri Children's Hospital, New York, NY, USA.

出版信息

Plast Surg (Oakv). 2019 May;27(2):125-129. doi: 10.1177/2292550319826092. Epub 2019 Mar 13.

Abstract

PURPOSE

In syndromic craniosynostosis, the Le Fort III osteotomy is used to correct dental/skeletal imbalance, improve exorbitism, and increase the airway. The purpose of this study is to perform a cost comparison between the standard technique of single-stage rigid internal fixation and distraction osteogenesis (DO) in the Le Fort III osteotomy in this patient population.

METHOD

Hospital cost accounting databases were queried for patients undergoing single-stage advancement (SS) or DO from 2007 to 2016. Nominal cost data were adjusted using the Bank of Canada Consumer Price Index. Reported costs represented the full length of stay for all utilization per patient. Demographic information and cost data for single-stage osteotomy and DO were compared.

RESULTS

Total costs for single-stage (n = 8) were higher than distraction (n = 6; mean $CAD57 825 vs $38 268, < .05). Intensive care unit (ICU) costs for single-stage were significantly higher than distraction (mean, $17 746 vs $5585, < .005). Distraction cases had higher operating room (OR) costs than single stage, but the difference was not significant (mean, $12 540 vs $9696). Length of stay was significantly longer for SS patients (mean, 11 days vs 7 days, < .05).

CONCLUSIONS

This single-institution retrospective cost analysis indicates standard SS rigid internal fixation Le Fort III is more costly than DO. Despite higher OR costs, prolonged ICU and hospital stay was the primary reason behind this difference. This information may be of benefit when advocating for new technology perceived as high cost.

摘要

目的

在综合征性颅缝早闭中,Le Fort III截骨术用于纠正牙/骨骼失衡、改善眼球突出并增加气道。本研究的目的是对该患者群体中Le Fort III截骨术的单阶段刚性内固定标准技术与牵张成骨术(DO)进行成本比较。

方法

查询2007年至2016年接受单阶段前移(SS)或DO的患者的医院成本核算数据库。使用加拿大银行消费者物价指数对名义成本数据进行调整。报告的成本代表每位患者所有医疗服务的住院总时长。比较单阶段截骨术和DO的人口统计学信息及成本数据。

结果

单阶段(n = 8)的总成本高于牵张成骨术(n = 6;平均57825加元对38268加元,P <.05)。单阶段的重症监护病房(ICU)成本显著高于牵张成骨术(平均17746加元对5585加元,P <.005)。牵张成骨术病例的手术室(OR)成本高于单阶段,但差异不显著(平均12540加元对9696加元)。SS患者的住院时长显著更长(平均11天对7天,P <.05)。

结论

这项单机构回顾性成本分析表明,标准的SS刚性内固定Le Fort III比DO成本更高。尽管手术室成本较高,但ICU和住院时间延长是造成这种差异的主要原因。在倡导被视为高成本的新技术时,这些信息可能会有所帮助。

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