Cost Analysis of 109 Microsurgical Reconstructions and Flap Monitoring with Microdialysis

Abstract

Few studies have examined the cost-effectiveness of microsurgery, and little is known about the cost-effectiveness of flap monitoring. We studied the costs related to microsurgery during 2004 to 2006 in Kuopio University Hospital. A total of 99 patients were reconstructed with 109 flaps. Primary success was achieved in 64% of cases. Reoperation for anastomosis was conducted in 25% and for other surgical complications in 27%. The intended result was achieved in 94% of cases. The mean total cost of hospital care was 20,000 euro in head and neck cancer surgery, 15,500 euro in defects of the lower extremities, and 9200 euro in breast reconstruction. The costs were greatly influenced by surgical complications (i.e., if the primary reconstruction failed, then the secondary microvascular flap almost doubled the expense involved; mean expenses per case 27,900 euro). Microdialysis was used in flap monitoring with an additional cost of 535 euro per patient. We found that microdialysis provided an early diagnosis of perfusion failure and helped to save the flap. It was estimated that if one or two flaps per year are saved due to more effective monitoring, then the extra costs of using microdialysis are covered.

The Economic Burden of Head and Neck Cancer: A Systematic Literature Review

“…In the current review, 20 publications from 19 studies described costs attributable to symptoms and side effects arising directly from the various treatments for HNC [11, 13, 15, 16, 25, 32, 36, 39, 42, 45, 47, 49, 50, 54, 59, 60, 73, 75, 76, 94]. The most commonly reported costs for treatment-related complications were due to infection [15, 16, 39, 45, 49, 59, 73] and surgical reconstruction following tumor resection [11, 36, 60, 75, 94].…”

“…The most commonly reported costs for treatment-related complications were due to infection [15, 16, 39, 45, 49, 59, 73] and surgical reconstruction following tumor resection [11, 36, 60, 75, 94]. Expenses for several other treatment-emergent side effects were noted, including peripheral neuropathy [50], dermatologic adverse drug reactions, acute mucositis [13, 25, 47, 54], osteoradionecrosis [76], and deep vein thrombosis or pulmonary embolism [32].…”

“…Expenses for several other treatment-emergent side effects were noted, including peripheral neuropathy [50], dermatologic adverse drug reactions, acute mucositis [13, 25, 47, 54], osteoradionecrosis [76], and deep vein thrombosis or pulmonary embolism [32]. The majority of these studies ( n  = 12) evaluated economic data in the USA, and one economic analysis each was performed in the Netherlands [13], Canada [76], Finland [60], France [49], Ireland [73], and Taiwan [16]. …”

Remote Monitoring of Perforator Flaps Using an Innovative Device with an Application for Mobile Phone: A Pilot Study

“…Currently, the most reliable method is the use of internal Doppler probes, which are placed beside the anastomosis and continuously measure the flow. [2][3][4][5][6][7][8][9][10][11][12][13]19 However, this method is not very popular in some countries such as Mexico because the cost of the device is unaffordable by most health institutions or by the patient. Direct thermography has been well established as a reliable monitoring method and is used in many hospitals worldwide due to its low cost and easy interpretation.…”

“…[2][3][4][5][6][7][8] Other methods used for monitoring perforator flaps are direct thermography, implantable Doppler, external Doppler, microdialysis, infrared oximetry flow, angiography, and images transmitted by electronic devices. These are but a few of the currently designed systems.…”