title: Are virtual planning and guided surgery for head and neck reconstruction economically viable?
abstract: OBJECTIVE
  Virtual planning and guided surgery with or without prebent or milled plates are becoming more and more common for mandibular reconstruction with fibular free flaps (FFFs). Although this excellent surgical option is being used more widely, the question of the additional cost of planning and cutting-guide production has to be discussed. In capped payment systems such additional costs have to be offset by other savings if there are no special provisions for extra funding. Our study was designed to determine whether using virtual planning and guided surgery resulted in time saved during surgery and whether this time gain resulted in self-funding of such planning through the time saved.
  
  
  METHODS
  All consecutive cases of FFF surgery were evaluated during a 2-year period. Institutional data were used to determine the price of 1 minute of operative time. The time for fibula molding, plate adaptation, and insetting was recorded.
  
  
  RESULTS
  During the defined period, we performed 20 mandibular reconstructions using FFFs, 9 with virtual planning and guided surgery and 11 freehand cases. One minute of operative time was calculated to cost US $47.50. Multiplying this number by the time saved, we found that the additional cost of virtual planning was reduced from US $5,098 to US $1,231.50 with a prebent plate and from US $6,980 to US $3,113.50 for a milled plate.
  
  
  CONCLUSIONS
  Even in capped health care systems, virtual planning and guided surgery including prebent or milled plates are financially viable.
authors.affiliation: Consultant, Maxillofacial Surgery Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. Electronic address: daniel.zweifel@chuv.ch.
authors.forename: Daniel Fritz
authors.initials: DF
authors.lastname: Zweifel
authors.affiliation: Chief Consultant, Ear-Nose and Throat Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Simon
authors.affiliation: Consultant, Maxillofacial Surgery Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Remy
authors.initials: R
authors.lastname: Hoarau
authors.affiliation: Consultant, Ear-Nose and Throat Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Pasche
authors.affiliation: Chief Consultant, Maxillofacial Surgery Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Broome
mesh_terms: D000368:Aged; D000792:Angiography / Q000191:economics; D001860:Bone Plates / Q000191:economics; D016025:Bone Transplantation / Q000191:economics; D002294:Carcinoma, Squamous Cell / Q000191:economics / Q000601:surgery; D003198:Computer Simulation / Q000191:economics; D017046:Cost Savings; D003953:Diagnosis-Related Groups / Q000191:economics; D005260:Female; D005360:Fibula / Q000601:surgery; D058752:Free Tissue Flaps / Q000637:transplantation; D017048:Health Care Costs; D017721:Hospital Costs; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000191:economics; D008297:Male; D008339:Mandibular Neoplasms / Q000191:economics / Q000601:surgery; D063175:Mandibular Reconstruction / Q000191:economics* / Q000295:instrumentation; D008875:Middle Aged; D008953:Models, Anatomic; D061646:Operative Time; D010347:Patient Care Planning / Q000191:economics*; D011446:Prospective Studies; D025321:Surgery, Computer-Assisted / Q000191:economics*; D013557:Switzerland; D014057:Tomography, X-Ray Computed / Q000191:economics; D060053:Transplant Donor Site / Q000601:surgery; D014584:User-Computer Interface