Lorquet Etienne, Govshievich Alexander, Chollet André, Tremblay Dominique M, Borsuk Daniel E
Maisonneuve Rosemont Hospital, Montreal, Quebec, Canada.
Plast Reconstr Surg Glob Open. 2021 Jan 25;9(1):e3357. doi: 10.1097/GOX.0000000000003357. eCollection 2021 Jan.
Facial transplantation (FT) is recognized as the ultimate reconstruction for severely disfigured patients. The substantial cost of these procedures in a nationalized health system has not been extensively published. The first Canadian FT performed in May 2018 was a great opportunity to address this subject and evaluate the viability of such a program.
A detailed patient chart review was performed and a cost per unit approach was used to estimate the procedure cost. The preoperative, operative, and the postoperative periods up to 1-year after the surgery were analyzed. Financial support from private sponsors and Hospital Fund donations were considered. The literature on international FT and national solid organ transplantation was reviewed.
The overall 1-year cost was estimated at $440,224 (2018 CAD). The costs are explained by a long hospital length of stay, costly immunosuppressive therapy, and high immunosuppression-related complications. Those findings are consistent with international FT literature. The societal impact of the surgery was minimized with a $36,921 (2018 CAD) grant obtained from an external contributor. Interestingly, the hospital foundation sustained a 794% increase in donations ($1,787,148; 2019 CAD) the year following the surgery.
Our experience confirmed that the combination of private funding, with positive goodwill and hospital donations, is a workable model for innovative surgery in the setting of a nationalized health system with financial restrictions.
面部移植（FT）被认为是严重毁容患者的最终重建方式。在国有医疗系统中，这些手术的高昂成本尚未得到广泛公布。2018年5月在加拿大进行的首例面部移植手术是探讨这一主题并评估此类项目可行性的绝佳机会。
对患者病历进行了详细审查，并采用单位成本法估算手术成本。分析了术前、术中以及术后长达1年的情况。考虑了私人赞助商的资金支持和医院基金捐赠。查阅了关于国际面部移植和国家实体器官移植的文献。
1年的总成本估计为440,224加元（2018年加拿大元）。成本高是由于住院时间长、免疫抑制治疗费用高以及与免疫抑制相关的并发症多。这些发现与国际面部移植文献一致。通过从外部捐助者获得36,921加元（2018年加拿大元）的赠款，将手术对社会的影响降至最低。有趣的是，在手术后的一年里，医院基金会的捐赠增加了794%（1,787,148加元；2019年加拿大元）。
我们的经验证实，在财政受限的国有医疗系统背景下，私人资金与积极的善意及医院捐赠相结合，是创新手术的可行模式。
