title: Medicoeconomic study of microsurgical head and neck reconstructions.
abstract: OBJECTIVE
  The use of microanastomosed free flaps has become essential in the management of head and neck defects following cancer resection or other causes. However, this surgery is under-rated by the French case-mix based rating procedure. The purpose of this study was to evaluate the cost balance of this type of surgery in a patient cohort managed by free flap head and neck reconstruction in a polyvalent adult head and neck surgery department.
  
  
  METHODS
  This retrospective study was based on 52 patients divided into two groups undergoing either mandibular or nonmandibular reconstruction. Possible prognostic factors were investigated in patients undergoing mandibular reconstruction. Kaplan-Meier survival analysis was also performed for both groups of patients. The Foch Hospital financial department's analytical accounting data for 2006 and 2007 were used to evaluate the costs related to these patients. A senior surgeon retrospectively reviewed the patients' charts with the Medical Informatics physician in order to optimize the choice of diagnosis-related group (DRG).
  
  
  RESULTS
  The mean income generated by mandibular and nonmandibular reconstructions in 2006 and 2007 was 545€/day and 526€/day for hospitalisation including free flap and 828€/day and 818€/day for "satellite" hospitalisations for other procedures related to the reconstruction, respectively. After review of the rating by a senior surgeon, in order to optimize the choice of DRG, the mean income received by the hospital could have been improved by +6%.
  
  
  CONCLUSIONS
  Optimization of procedure and hospital stay rating associated with better collaboration with the Medical Informatics physician are essential in order to continue to provide this major surgery, which is essential for the patient's quality of life. A higher rating of this activity by the French health system is also necessary.
authors.affiliation: Service de Chirurgie de la Tête et du Cou (ORL), Hôpital Foch, 40, rue Worth, 92150 Suresnes, France. b.baujat@hopital-foch.org
authors.forename: B
authors.initials: B
authors.lastname: Baujat
authors.forename: K
authors.initials: K
authors.lastname: Altabaa
authors.forename: M
authors.initials: M
authors.lastname: Meyers
authors.forename: I
authors.initials: I
authors.lastname: Wagner
authors.forename: C
authors.initials: C
authors.lastname: Leclerc
authors.forename: F
authors.initials: F
authors.lastname: Chabolle
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D003365:Costs and Cost Analysis; D003953:Diagnosis-Related Groups / Q000191:economics*; D005147:Facial Bones / Q000601:surgery*; D005260:Female; D005602:France; D058752:Free Tissue Flaps / Q000191:economics; D006258:Head and Neck Neoplasms / Q000601:surgery*; D017721:Hospital Costs; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008334:Mandible / Q000601:surgery; D008866:Microsurgery / Q000191:economics*; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000191:economics*; D015895:Relative Value Scales; D012189:Retrospective Studies; D055815:Young Adult