The financial burden for the surgical management of osteoradionecrosis

Abstract

Osteoradionecrosis (ORN) remains a difficult clinical problem. In large refractory cases surgery appears to be the only option but it does not guarantee a cure and is expensive. Cost analysis of 31 patients who had resection with or without reconstruction of their mandible was £892,357. The largest cost was in-patient stay, which accounted for 62% of the total. This article explores in detail the expenditure associated with major ORN surgery and its subsequent implications.

Is there a role for medical management in the treatment of extreme mandibular osteoradionecrosis with pathological fractures?

“…Hence, an alternative strategy via a focused pharmacological approach attempting to counterbalance RIF changes has been hugely welcomed. The current anecdotal clinical evidence alongside the previously reported cases 241161213 suggests that medical management can be successful even in the extreme ORN cases for which surgery was the standard of care 21 .…”

“…However, post-operative quality of life scores did not reflect the surgical success with Löfstrand et al 20 reporting a high incidence of difficulties with swallowing and eating socially following fibular free flap reconstruction in ORN patients. Furthermore, surgical intervention carries significant risks such as failure, further fibrosis and the need for enteral feeding via a percutaneous endoscopic gastrostomy tube 21 . Conversely PENTO has been shown to help with secondary RIF factors such as trismus and mucositis 22,23,12 .…”

“…Beyond the clinical complexities of managing ORN surgically, there remains a significant financial and hospital resource burden via this approach. Patel et al demonstrated that the overall mean cost of surgical intervention ranges from £20,189 upwards compared with £375/year for PENTO therapy 21 . When considering our longest treatment time in the above cases this equates to £2159.70.…”

Management of laryngeal chondroradionecrosis with pentoxifylline and vitamin E: A case report and review of the literature

“…The PENTO regime costs approximately £30/month, which amounted to £255 in the reported case. Compared with the financial burden of surgically managing ORN, 47 this is a cost‐effective alternative. Despite success in the medium term for this patient, additional long‐term observational studies with larger patient cohorts and research are warranted investigating the effects of PENTO on LCRN.…”

Robot-Assisted Reconstruction in Head and Neck Surgical Oncology: The Evolving Role of the Reconstructive Microsurgeon

“…In the short term, a reduced operation time and length of hospital stay as well as a quicker return of swallow have been reported [14]. In the long term, a reduction in primary CRT and de-escalation of postoperative CRT through TORS pathways may reduce the incidence of osteoradionecrosis, which carries a large economic burden and has a significant impact on quality of life [15][16][17]. It should be pointed out that there is a steep learning curve for the surgeon performing TORS, and managing complex and salvage cases should not be undertaken early on in this process [9].…”