title: Is a computer-assisted design and computer-assisted manufacturing method for mandibular reconstruction economically viable?
abstract: The design and manufacture of patient-specific mandibular reconstruction plates, particularly in combination with cutting guides, has created many new opportunities for the planning and implementation of mandibular reconstruction. Although this surgical method is being used more widely and the outcomes appear to be improved, the question of the additional cost has to be discussed. To evaluate the cost generated by the management of this technology, we studied a cohort of patients treated for mandibular neoplasms. The population was divided into two groups of 20 patients each who were undergoing a 'traditional' freehand mandibular reconstruction or a computer-aided design/computer-aided manufacturing (CAD-CAM) mandibular reconstruction. Data concerning operation time, complications, and days of hospitalisation were used to evaluate costs related to the management of these patients. The mean operating time for the CAD-CAM group was 435 min, whereas that for the freehand group was 550.5 min. The total difference in terms of average time gain was 115.5 min. No microvascular complication occurred in the CAD-CAM group; two complications (10%) were observed in patients undergoing freehand reconstructions. The mean overall lengths of hospital stay were 13.8 days for the CAD-CAM group and 17 days for the freehand group. Finally, considering that the institutional cost per minute of theatre time is €30, the money saved as a result of the time gained was €3,450. This cost corresponds approximately to the total price of the CAD-CAM surgery. In conclusion, we believe that CAD-CAM technology for mandibular reconstruction will become a widely used reconstructive method and that its cost will be covered by gains in terms of surgical time, quality of reconstruction, and reduced complications.
authors.affiliation: Maxillofacial Surgery Unit, S. Orsola-Malpighi Hospital (Head: Prof. Claudio Marchetti), Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Via S. Vitale 59, 40125 Bologna, Italy. Electronic address: achille.tarsitano2@unibo.it.
authors.forename: Achille
authors.initials: A
authors.lastname: Tarsitano
authors.affiliation: Maxillofacial Surgery Unit, S. Orsola-Malpighi Hospital (Head: Prof. Claudio Marchetti), Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Via S. Vitale 59, 40125 Bologna, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Battaglia
authors.affiliation: Maxillofacial Surgery Unit (Head: Prof. Francesco De Ponte), University of Messina, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Crimi
authors.affiliation: Section of Prosthodontics, Department of Biomedical and Neuromotor Sciences (Head: Prof. Roberto Scotti), Alma Mater Studiorum University of Bologna, Via S. Vitale 59, 40125 Bologna, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Ciocca
authors.affiliation: Section of Prosthodontics, Department of Biomedical and Neuromotor Sciences (Head: Prof. Roberto Scotti), Alma Mater Studiorum University of Bologna, Via S. Vitale 59, 40125 Bologna, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Scotti
authors.affiliation: Maxillofacial Surgery Unit, S. Orsola-Malpighi Hospital (Head: Prof. Claudio Marchetti), Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Via S. Vitale 59, 40125 Bologna, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Marchetti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D017076:Computer-Aided Design; D005260:Female; D005360:Fibula / Q000637:transplantation; D058752:Free Tissue Flaps / Q000009:adverse effects / Q000191:economics / Q000637:transplantation; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008339:Mandibular Neoplasms / Q000601:surgery*; D063175:Mandibular Reconstruction / Q000009:adverse effects / Q000191:economics* / Q000379:methods*; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications; D011446:Prospective Studies; D055815:Young Adult
keywords: Computer-aided design; Computer-aided manufacturing; Cost; Mandibular reconstruction; Reconstructive surgery; Surgical time