A financial analysis of maxillomandibular fixation versus rigid internal fixation for treatment of mandibular fractures.
OBJECTIVE
The aim of this study was to compare the cost-effectiveness of mandibular fracture treatment by closed reduction with maxillomandibular fixation (CRF) with open reduction and rigid internal fixation (ORIF).


METHODS
This was a retrospective study of 85 patients admitted to the Oral and Maxillofacial Surgery Service at San Francisco General Hospital and treated for mandibular fractures from January 1 to December 31, 1993. The patients were divided into 2 groups: 1) those treated with CRF and 2) those treated with ORIF. The outcome variables were length of hospital stay, duration of anesthesia, and time in operating room. The charge for primary fracture treatment included the fees for the operation and hospitalization without any complications. Within the group of 85 patients treated for mandibular fractures in 1993, 10 patients treated with CRF and 10 patients treated with ORIF were randomly selected, and hospital billing statements were used to estimate the average charge of primary treatment. The average charge to manage a major postoperative infection also was estimated based on the billing statements of 10 randomly selected patients treated in 1992 (5 treated with CRF, 5 with ORIF) who required hospital admission for the management of a complication. The average total charge was computed by using the average charge for primary treatment plus the incidence of postoperative infection multiplied by the average charge for management of that complication.


RESULTS
Eighty-five patients were included in the study. The average charge for primary treatment was $10,100 for the CRF group and $28,362 for the ORIF group. The average charge for the inpatient management of a major postoperative infection was $26,671 for the CRF group and $39,213 for the ORIF group. The average total charge for management of a mandible fracture with CRF was $10,927; the total charge for the ORIF group was $34,636.


CONCLUSIONS
The results of this retrospective study suggest that the use of CRF in the management of mandibular fractures at our institution provides considerable savings over treatment by using ORIF. The use of ORIF should be reserved for patients and fracture types with specific indications.
Schmidt
B L
BL
Department of Oral and Maxillofacial Surgery, University of California, San Francisco, USA. briansc@itsa.ucsf.edu
Kearns
G
G
Gordon
N
N
Kaban
L B
LB
D000328:Adult; D003362:Cost-Benefit Analysis; D005251:Fees, Medical; D005260:Female; D005592:Fracture Fixation / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D017722:Hospital Charges; D006801:Humans; D007103:Immobilization; D019248:Jaw Fixation Techniques / Q000191:economics*; D007902:Length of Stay / Q000191:economics; D008297:Male; D008337:Mandibular Fractures / Q000191:economics* / Q000601:surgery / Q000628:therapy*; D011897:Random Allocation; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013530:Surgical Wound Infection / Q000191:economics