scholarly journals The Cost of Care Associated with Microvascular Free Tissue Transfer by Anatomical Region: A Time-Driven Activity-Based Model

2021 ◽  
Vol 06 (01) ◽  
pp. e28-e34
Author(s):  
Jackson S. Lindell ◽  
Breanna L. Blaschke ◽  
Arthur J. Only ◽  
Harsh R. Parikh ◽  
Tiffany L. Gorman ◽  
...  
Keyword(s):  
Cost Reduction ◽  
Indirect Costs ◽  
Free Tissue Transfer ◽  
Cost Of Care ◽  
Icu Stay ◽  
Cumulative Cost ◽  
Tissue Transfer ◽  
Level I ◽  
The Cost ◽  
Tissue Defects

Abstract Background Microvascular free tissue transfer (FTT) is a reliable method for reconstruction of complex soft tissue defects. The goal of this study was to utilize time-driven activity-based cost (TDABC) accounting to measure the total cost of care of FTT and identify modifiable cost drivers. Methods A retrospective review was performed on patients requiring FTT at a single, level-I academic trauma center from 2013 to 2019. Patient and surgical characteristics were collected, and six prospective FTT cases were observed via TDABC to collect direct and indirect costs of care. Results When stratified by postoperative stay at intensive care units (ICUs), the average cost of care was $21,840.22, while cases without ICU stay averaged $6,646.61. The most costly category was ICU stay, averaging $8,310.99 (40.9% of nonstratified overall cost). Indirect costs were the second most costly category, averaging $4,388.07 (21.6% of nonstratified overall cost). Overall, 13 of 100 reviewed cases required some form of revision free-flap, increasing cumulative costs to $7,961.34 for cases with non-ICU stay and $22,233.85 for cases with ICU stay, averaging up to $44,074.07 for patients who stayed in the ICU for both procedures. An increase in cumulative cost was also observed within the timeframe of the investigation, with average costs of $8,484.00 in 2013 compared to $45,128 for 2019. Conclusion Primary drivers for cost in this study were ICU stay and revision/reoperation. Better understanding the cost of FTT allows for cost reduction through the development of new protocols that drive intraoperative efficiency, reduce ICU stays, and optimize outcomes.

scholarly journals Cost of care of chronic non-communicable diseases in Jamaican patients: the role of obesity

2016 ◽  
Vol 17 (2) ◽  
pp. 81-95
Author(s):  
Christine M. Fray-Aiken ◽  
Rainford J. Wilks ◽  
Abdullahi O. Abdulkadri ◽  
Affette M. McCaw-Binns
Keyword(s):  
Cost Of Illness ◽  
Hospital Setting ◽  
Indirect Costs ◽  
Communicable Diseases ◽  
Cost Of Care ◽  
Total Direct Cost ◽  
Non Communicable Diseases ◽  
Female Patients ◽  
Per Capita ◽  
The Cost

OBJECTIVE: To estimate the economic cost of Chronic Non-Communicable Diseases (CNCDs) and the portion attributable to obesity among patients in Jamaica.METHODS: The cost-of-illness approach was used to estimate the cost of care in a hospital setting in Jamaica for type 2 diabetes mellitus, hypertension, coronary heart disease, stroke, gallbladder disease, breast cancer, colon cancer, osteoarthritis, and high cholesterol. Cost and service utilization data were collected from the hospital records of all patients with these diseases who visited the University Hospital of the West Indies (UHWI) during 2006. Patients were included in the study if they were between15 and 74 years of age and if female, were not pregnant during that year. Costs were categorized as direct or indirect. Direct costs included costs for prescription drugs, consultation visits (emergency and clinic visits), hospitalizations, allied health services, diagnostic and treatment procedures. Indirect costs included costs attributed to premature mortality, disability (permanent and temporary), and absenteeism. Indirect costs were discounted at 3% rate.RESULTS: The sample consisted of 554 patients (40%) males (60%) females. The economic burden of the nine diseases was estimated at US$ 5,672,618 (males 37%; females 63%) and the portion attributable to obesity amounted to US$ 1,157,173 (males 23%; females 77%). Total direct cost was estimated at US$ 3,740,377 with female patients accounting for 69.9% of this cost. Total indirect cost was estimated at US$ 1,932,241 with female patients accounting for 50.6% of this cost. The greater cost among women was not found to be statistically significant. Overall, on a per capita basis, males and females accrued similar costs-of-illness (US$ 9,451.75 vs. US$ 10,758.18).CONCLUSIONS: In a country with per capita GDP of less than US$ 5,300, a per capita annual cost of illness of US$ 10,239 for CNCDs is excessive and has detrimental implications for the health and development of Jamaica.

scholarly journals Extended reverse sural artery pedicle flap: a versatile and reproducible option for coverage of ankle and foot defects

2019 ◽  
Vol 7 (3) ◽  
pp. 866
Author(s):  
Bhushan R. Patil ◽  
Chandrashekhar Wahegaonkar ◽  
Nikhil Agarkhedkar ◽  
Bharat Bhushan Dogra
Keyword(s):  
Soft Tissue ◽  
Weight Bearing ◽  
Free Tissue Transfer ◽  
Soft Tissue Defects ◽  
Pedicle Flap ◽  
Tissue Transfer ◽  
Major Vessel ◽  
Sural Artery ◽  
Tissue Defects ◽  
Ankle And Foot

Background: Coverage of soft tissue defects around distal third of the leg, particularly ankle and foot is a common situation faced by a plastic and reconstructive surgeon. Options available for such defects are limited due to scarcity of additional soft tissue that can be used without exposing tendons or bone. Associated conditions such as major vascular compromise, comorbidities and lack of facilities or expertise make free tissue transfer less preferred. Distally based sural artery flap has been a frequently used flap in such conditions, easy to perform and has reproducible results. We extended the reach of the flap and reproduced the results.Methods: We performed extended reverse sural artery pedicled flaps in 19 patients who presented to us between 2015 to 2017 with soft tissue defects around ankle and foot. Patients included 15 post RTA, 2 diabetic foot, 1 post resection defect and 1 post burn contracture release defect. Size of the defect ranged between 8x6cm to 14x10cm. Average follow up period was ranging from 8 months to 2.5 years.Results: All the flaps healed well without any obvious complications except one patient in whom marginal necrosis (2 cm margin of distal most flap) was observed and was secondarily treated with skin grafting.Conclusions: We observed that extended reverse sural pedicle flap is a rapid, reliable option for coverage of soft tissue defects around ankle and heel, sparing major vessel compromise and lengthy surgical procedure during free tissue transfer. This flap should be the first option for the patients with trauma and defects over weight bearing foot in whom peroneal axis vessels are preserved.

Simultaneous pedicled flaps for coverage of complex blast injuries to the forearm and hand (with supplemental external fixation to the iliac crest for immobilization)

2009 ◽  
Vol 35 (1) ◽  
pp. 9-15 ◽  
Author(s):  
S. M. Tintle ◽  
K. Wilson ◽  
P. L. McKay ◽  
R. C. Andersen ◽  
A. R. Kumar
Keyword(s):  
Soft Tissue ◽  
Military Personnel ◽  
Iliac Crest ◽  
Free Tissue Transfer ◽  
Blast Injuries ◽  
Soft Tissue Defects ◽  
Pedicled Flaps ◽  
Tissue Transfer ◽  
Extremity Reconstruction ◽  
Tissue Defects

The technique of two simultaneous pedicled flaps to a single extremity has recently proven useful in the care of war-injured military personnel. We present two cases of combat-injured Marines who underwent upper extremity reconstruction using simultaneous pedicled flaps. These cases illustrate a simple and successful alternative to free tissue transfer in providing coverage to complex soft tissue defects of the hand and forearm. Good outcomes were obtained in circumstances where free tissue transfer was not indicated.

scholarly journals Latissimus dorsi free tissue transfer for coverage of extensive soft tissue defects

1995 ◽  
Vol 66 (sup264) ◽  
pp. 31-34 ◽  
Author(s):  
Alexandras E Beris ◽  
Panayotis N Soucacos ◽  
Theodore A Xenakis ◽  
Sakis Zaravelas ◽  
Gregory Mitsionis ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Latissimus Dorsi ◽  
Free Tissue Transfer ◽  
Soft Tissue Defects ◽  
Tissue Transfer ◽  
Tissue Defects

scholarly journals A Review of Pedicled Perforator Flaps for Reconstruction of the Soft Tissue Defects of the Leg and Foot

2019 ◽  
Vol 52 (01) ◽  
pp. 026-036 ◽  
Author(s):  
O-Wern Low ◽  
Sandeep J. Sebastin ◽  
Andre E. J. Cheah
Keyword(s):  
Soft Tissue ◽  
Lower Extremity ◽  
Surgical Techniques ◽  
Perforator Flap ◽  
Free Tissue Transfer ◽  
High Energy ◽  
Soft Tissue Defects ◽  
Perforator Flaps ◽  
Tissue Transfer ◽  
Tissue Defects

AbstractLower extremity soft tissue defects frequently result from high-energy trauma or oncological resection. The lack of suitable muscle flap options for the distal leg and foot makes defects in these locations especially challenging to reconstruct and free tissue transfer is commonly used. Another option that has become more popular in the past two decades are pedicled perforator flaps. Based on a thorough literature review and the authors’ experience on leg perforator flaps for over a decade, this article presents a historical review, the anatomical basis of common perforator flaps of the leg and foot, patient selection, wound selection, perforator selection, flap design, surgical techniques, refinements, and postoperative care. A review of the clinical outcomes and complications of these flaps was also performed and was noted to be comparable to the outcomes of free tissue transfer with significantly lower total flap failure rate. It is hoped that this review will assist surgeons in the formulation of a comprehensive step-by-step guide in performing pedicled perforator flap reconstruction of the lower extremity.

scholarly journals Is free tissue transfer following necrotising fasciitis safe? A case report and review

2019 ◽  
Vol 2 (1) ◽  
pp. 99-102
Author(s):  
Daniel Bunker ◽  
Scott Ferris
Keyword(s):  
Free Tissue Transfer ◽  
Skin Grafting ◽  
Necrotising Fasciitis ◽  
Tissue Transfer ◽  
Reconstructive Option ◽  
Life Threatening ◽  
Infection And Inflammation ◽  
Radical Debridement ◽  
Tissue Defects ◽  
Reconstructive Methods

Necrotising fasciitis is a life-threatening infection that requires radical debridement, usually accompanied by antibiotic therapy and physiologic support. Patients are often left with disabling or disfiguring soft tissue defects. Traditionally, simple reconstructive methods such as skin grafting and local flap coverage have been used to address these defects, due to concerns that free tissue transfer may increase the risk of thrombosis following infection and inflammation. We argue that once the infection has been cleared and the patient regains stability, free tissue transfer is a viable reconstructive option that may provide better functional and cosmetic results in selected cases.

scholarly journals Microsurgery Technique in the Foot Reconstruction of Soft Tissue Defects: A Review of 4 Cases

1970 ◽  
Vol 1 (1) ◽  
Author(s):  
Parintosa Atmodiwirjo ◽  
Afriyanti Sandhi
Keyword(s):  
Soft Tissue ◽  
Donor Site ◽  
Free Tissue Transfer ◽  
Donor Site Morbidity ◽  
Soft Tissue Defects ◽  
Tissue Transfer ◽  
Anterolateral Thigh ◽  
Radial Forearm ◽  
Foot Reconstruction ◽  
Tissue Defects

The restoration of an intact covering is the primary surgical requisite following soft tissue defects in the foot because deep healing can be no better than the surface covering. Soft tissue defects that expose underlying bones, joints, and tendons pose challenging problems and require a free tissue transfer for a successful reconstruction.Total of 4 flaps in the foot was performed between February 2009 to February 2010. We reconstructed soft tissue defects in the foot in 4 patients using 3 free anterolateral thigh (ALT) flaps and 1 free radial forearm (RF) flap. Trauma was the commonest cause in our patients.Free ALT and RF flaps provided stable and durable long-term wound cover in all patients. Complications were few and manageable.Free tissue transfer has become commonplace in many centers around the world. The numerous advantages include stable wound coverage; improve aesthetic and functional outcomes, and minimal donor site morbidity. In our experience, we found that the using of free ALT and RF flaps in foot defects reconstruction, to be technically affordable, reliable and have resulted in excellent outcomes.

Cost and quality of life outcome analysis of postoperative infections after subaxial dorsal cervical fusions

2015 ◽  
Vol 22 (4) ◽  
pp. 381-386 ◽  
Author(s):  
Benjamin D. Kuhns ◽  
Daniel Lubelski ◽  
Matthew D. Alvin ◽  
Jason S. Taub ◽  
Matthew J. McGirt ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Health Outcomes ◽  
Financial Burden ◽  
Indirect Costs ◽  
Cost Of Care ◽  
Wound Infections ◽  
Deep Wound ◽  
The Cost

OBJECT Infections following spine surgery negatively affect patient quality of life (QOL) and impose a significant financial burden on the health care system. Postoperative wound infections occur at higher rates following dorsal cervical procedures than ventral procedures. Quantifying the health outcomes and costs associated with infections following dorsal cervical procedures may help to guide treatment strategies to minimize the deleterious consequences of these infections. Therefore, the goals of this study were to determine the cost and QOL outcomes affecting patients who developed deep wound infections following subaxial dorsal cervical spine fusions. METHODS The authors identified 22 (4.0%) of 551 patients undergoing dorsal cervical fusions who developed deep wound infections requiring surgical debridement. These patients were individually matched with control patients who did not develop infections. Health outcomes were assessed using the EQ-5D, Pain Disability Questionnaire (PDQ), Patient Health Questionnaire (PHQ-9), and visual analog scale (VAS). QOL outcome measures were collected preoperatively and after 6 and 12 months. Health resource utilization was recorded from patient electronic medical records over an average follow-up of 18 months. Direct costs were estimated using Medicare national payment amounts, and indirect costs were based on patients' missed workdays and income. RESULTS No significant differences in preoperative QOL scores were found between the 2 cohorts. At 6 months postsurgery, the noninfection cohort had significant pre- to postoperative improvement in EQ-5D (p = 0.02), whereas the infection cohort did not (p = 0.2). The noninfection cohort also had a significantly higher 6-month postoperative EQ-5D scores than the infection cohort (p = 0.04). At 1 year postsurgery, there was no significant difference in EQ-5D scores between the groups. Health care–associated costs for the infection cohort were significantly higher ($16,970 vs $7658; p < 0.0001). Indirect costs for the infection cohort and the noninfection cohort were $6495 and $2756, respectively (p = 0.03). Adjusted for inflation, the total costs for the infection cohort were $21,778 compared with $9159 for the noninfection cohort, reflecting an average cost of $12,619 associated with developing a postoperative deep wound infection (p < 0.0001). CONCLUSIONS Dorsal cervical infections temporarily decrease patient QOL postoperatively, but with no long-term impact; they do, however, dramatically increase the cost of care. Knowledge of the financial burden of wound infections following dorsal cervical fusion may stimulate the development and use of improved prophylactic and therapeutic techniques to manage this serious complication.

Sign in / Sign up

Export Citation Format

Share Document