Is a computer-assisted design and computer-assisted manufacturing method for mandibular reconstruction economically viable?

Achille Tarsitano; Salvatore Battaglia; Salvatore Crimi; Leonardo Ciocca; Roberto Scotti; Claudio Marchetti

doi:10.1016/j.jcms.2016.04.003

Is a computer-assisted design and computer-assisted manufacturing method for mandibular reconstruction economically viable?

J Craniomaxillofac Surg. 2016 Jul;44(7):795-9. doi: 10.1016/j.jcms.2016.04.003. Epub 2016 Apr 13.

Authors

Achille Tarsitano¹, Salvatore Battaglia², Salvatore Crimi³, Leonardo Ciocca⁴, Roberto Scotti⁴, Claudio Marchetti²

Affiliations

¹ Maxillofacial Surgery Unit, S. Orsola-Malpighi Hospital (Head: Prof. Claudio Marchetti), Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Via S. Vitale 59, 40125 Bologna, Italy. Electronic address: achille.tarsitano2@unibo.it.
² Maxillofacial Surgery Unit, S. Orsola-Malpighi Hospital (Head: Prof. Claudio Marchetti), Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Via S. Vitale 59, 40125 Bologna, Italy.
³ Maxillofacial Surgery Unit (Head: Prof. Francesco De Ponte), University of Messina, Italy.
⁴ Section of Prosthodontics, Department of Biomedical and Neuromotor Sciences (Head: Prof. Roberto Scotti), Alma Mater Studiorum University of Bologna, Via S. Vitale 59, 40125 Bologna, Italy.

PMID: 27193477
DOI: 10.1016/j.jcms.2016.04.003

Abstract

The design and manufacture of patient-specific mandibular reconstruction plates, particularly in combination with cutting guides, has created many new opportunities for the planning and implementation of mandibular reconstruction. Although this surgical method is being used more widely and the outcomes appear to be improved, the question of the additional cost has to be discussed. To evaluate the cost generated by the management of this technology, we studied a cohort of patients treated for mandibular neoplasms. The population was divided into two groups of 20 patients each who were undergoing a 'traditional' freehand mandibular reconstruction or a computer-aided design/computer-aided manufacturing (CAD-CAM) mandibular reconstruction. Data concerning operation time, complications, and days of hospitalisation were used to evaluate costs related to the management of these patients. The mean operating time for the CAD-CAM group was 435 min, whereas that for the freehand group was 550.5 min. The total difference in terms of average time gain was 115.5 min. No microvascular complication occurred in the CAD-CAM group; two complications (10%) were observed in patients undergoing freehand reconstructions. The mean overall lengths of hospital stay were 13.8 days for the CAD-CAM group and 17 days for the freehand group. Finally, considering that the institutional cost per minute of theatre time is €30, the money saved as a result of the time gained was €3,450. This cost corresponds approximately to the total price of the CAD-CAM surgery. In conclusion, we believe that CAD-CAM technology for mandibular reconstruction will become a widely used reconstructive method and that its cost will be covered by gains in terms of surgical time, quality of reconstruction, and reduced complications.

Keywords: Computer-aided design; Computer-aided manufacturing; Cost; Mandibular reconstruction; Reconstructive surgery; Surgical time.

MeSH terms

Adolescent
Adult
Aged
Child
Computer-Aided Design*
Female
Fibula / transplantation
Free Tissue Flaps / adverse effects
Free Tissue Flaps / economics
Free Tissue Flaps / transplantation
Hospital Costs
Humans
Length of Stay / economics
Male
Mandibular Neoplasms / surgery*
Mandibular Reconstruction / adverse effects
Mandibular Reconstruction / economics*
Mandibular Reconstruction / methods*
Middle Aged
Operative Time
Postoperative Complications
Prospective Studies
Young Adult