Cost Outcomes of Virtual Surgical Planning in Head and Neck Reconstruction: A Systematic Review

Overview

Journal Head Neck

Specialties General Surgery
Oncology

Date 2024 Dec 31

PMID 39737872

Authors

Jenny B Xiao

Norbert Banyi

Khanh Linh Tran

Eitan Prisman

Affiliations

Soon will be listed here.

Abstract

Background: Virtual surgical planning (VSP) is an emerging method in head and neck reconstruction with demonstrated benefits, however, its economic viability is supported with mixed evidence.

Methods: A structured search was performed in five electronic databases. Studies that performed an economic evaluation on VSP in head and neck reconstruction were included. Data regarding VSP workflow, costs, and variables influencing costs were recorded and synthesized.

Results: Eighteen studies met the final inclusion criteria (n = 733). Fourteen out of 18 studies (78%) found that VSP either generated cost savings or was comparable to freehand surgery (FHS). The majority of cost savings were generated from reduced OR times and LOS/LOH. In addition, greater cost savings were associated with in-house VSP workflows compared to those that are outsourced.

Conclusion: VSP is potentially cost-beneficial compared to traditional unplanned surgery, however, substantial heterogeneity amongst methods and outcome measures impedes the generalizability of these findings.

Trial Registration: PROSPERO: CRD42024504398.

References

Seikaly H, Idris S, Chuka R, Jeffery C, Dzioba A, Makki F . The Alberta Reconstructive Technique: An Occlusion-Driven and Digitally Based Jaw Reconstruction. Laryngoscope. 2019; 129 Suppl 4:S1-S14. DOI: 10.1002/lary.28064. View

Moe J, Foss J, Herster R, Powell C, Helman J, Ward B . An In-House Computer-Aided Design and Computer-Aided Manufacturing Workflow for Maxillofacial Free Flap Reconstruction is Associated With a Low Cost and High Accuracy. J Oral Maxillofac Surg. 2020; 79(1):227-236. DOI: 10.1016/j.joms.2020.07.216. View

Kurlander D, Garvey P, Largo R, Yu P, Chang E, Hanasono M . The Cost Utility of Virtual Surgical Planning and Computer-Assisted Design/Computer-Assisted Manufacturing in Mandible Reconstruction Using the Free Fibula Osteocutaneous Flap. J Reconstr Microsurg. 2022; 39(3):221-230. DOI: 10.1055/s-0042-1755260. View

Pucci R, Weyh A, Smotherman C, Valentini V, Bunnell A, Fernandes R . Accuracy of virtual planned surgery versus conventional free-hand surgery for reconstruction of the mandible with osteocutaneous free flaps. Int J Oral Maxillofac Surg. 2020; 49(9):1153-1161. DOI: 10.1016/j.ijom.2020.02.018. View

Xia J, Phillips C, Gateno J, Teichgraeber J, Christensen A, Gliddon M . Cost-effectiveness analysis for computer-aided surgical simulation in complex cranio-maxillofacial surgery. J Oral Maxillofac Surg. 2006; 64(12):1780-4. DOI: 10.1016/j.joms.2005.12.072. View

Block O, Khromov T, Hoene G, Schliephake H, Brockmeyer P . In-house virtual surgical planning and guided mandibular reconstruction is less precise, but more economical and time-efficient than commercial procedures. Head Neck. 2024; 46(4):871-883. DOI: 10.1002/hed.27642. View

Coleman S, Burkey B, Day T, Resser J, Netterville J, Dauer E . Increasing use of the scapula osteocutaneous free flap. Laryngoscope. 2000; 110(9):1419-24. DOI: 10.1097/00005537-200009000-00001. View

de Kleijn B, Kraeima J, Wachters J, van der Laan B, Wedman J, Witjes M . Virtual 3D planning of tracheostomy placement and clinical applicability of 3D cannula design: a three-step study. Eur Arch Otorhinolaryngol. 2017; 275(2):451-457. DOI: 10.1007/s00405-017-4819-x. View

Orabona G, Abbate V, Maglitto F, Bonavolonta P, Salzano G, Romano A . Low-cost, self-made CAD/CAM-guiding system for mandibular reconstruction. Surg Oncol. 2018; 27(2):200-207. DOI: 10.1016/j.suronc.2018.03.007. View

10.

Sun R, Zhou Y, Malouta M, Cai Y, Shui C, Zhu L . Digital surgery group versus traditional experience group in head and neck reconstruction: a retrospective controlled study to analyze clinical value and time-economic-social effect. World J Surg Oncol. 2022; 20(1):220. PMC: 9245239. DOI: 10.1186/s12957-022-02677-0. View

11.

Urken M, Bridger A, Zur K, Genden E . The scapular osteofasciocutaneous flap: a 12-year experience. Arch Otolaryngol Head Neck Surg. 2001; 127(7):862-9. View

12.

Lignon J, Guerlain J, Bozec A, Gorphe P, Lauwers F, Vergez S . Multicentre evaluation of the interest in planned surgery for mandibular reconstruction with fibula free flap: a retrospective cohort study. Eur Arch Otorhinolaryngol. 2021; 278(9):3451-3457. DOI: 10.1007/s00405-020-06536-0. View

13.

Fatima A, Hackman T, Wood J . Cost-Effectiveness Analysis of Virtual Surgical Planning in Mandibular Reconstruction. Plast Reconstr Surg. 2019; 143(4):1185-1194. DOI: 10.1097/PRS.0000000000005418. View

14.

Kearns M, Ermogenous P, Myers S, Ghanem A . Osteocutaneous flaps for head and neck reconstruction: A focused evaluation of donor site morbidity and patient reported outcome measures in different reconstruction options. Arch Plast Surg. 2018; 45(6):495-503. PMC: 6258970. DOI: 10.5999/aps.2017.01592. View

15.

McDougall J, Furnback W, Wang B, Mahlich J . Understanding the global measurement of willingness to pay in health. J Mark Access Health Policy. 2020; 8(1):1717030. PMC: 7048225. DOI: 10.1080/20016689.2020.1717030. View

16.

Rodriguez-Arias J, Tapia B, Pampin M, Moran M, Gonzalez J, Barajas M . Clinical Outcomes and Cost Analysis of Fibula Free Flaps: A Retrospective Comparison of CAD/CAM versus Conventional Technique. J Pers Med. 2022; 12(6). PMC: 9224908. DOI: 10.3390/jpm12060930. View

17.

Page M, McKenzie J, Bossuyt P, Boutron I, Hoffmann T, Mulrow C . The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. PLoS Med. 2021; 18(3):e1003583. PMC: 8007028. DOI: 10.1371/journal.pmed.1003583. View

18.

Barr M, Haveles C, Rezzadeh K, Nolan I, Castro R, Lee J . Virtual Surgical Planning for Mandibular Reconstruction With the Fibula Free Flap: A Systematic Review and Meta-analysis. Ann Plast Surg. 2019; 84(1):117-122. DOI: 10.1097/SAP.0000000000002006. View

19.

Chen Z, Mo S, Fan X, You Y, Ye G, Zhou N . A Meta-analysis and Systematic Review Comparing the Effectiveness of Traditional and Virtual Surgical Planning for Orthognathic Surgery: Based on Randomized Clinical Trials. J Oral Maxillofac Surg. 2020; 79(2):471.e1-471.e19. DOI: 10.1016/j.joms.2020.09.005. View

20.

Husereau D, Drummond M, Augustovski F, De Bekker-Grob E, Briggs A, Carswell C . Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations. BMC Med. 2022; 20(1):23. PMC: 8753858. DOI: 10.1186/s12916-021-02204-0. View