Are “Free Flaps” “Free” Flaps?

2021 ◽  
Author(s):  
Geoffrey G. Hallock
Keyword(s):  
Free Flap ◽  
Private Practice ◽  
Free Flaps ◽  
Net Income ◽  
Benefit Cost Analysis ◽  
Work Related ◽  
Practice Experience ◽  
Pro Bono ◽  
Reconstructive Microsurgery ◽  
Benefit Cost

Abstract Background Even standard microvascular tissue transfers are time consuming, require great skill and intensity, and can be stressful. Not surprisingly, work-related relative value units are considered by many microsurgeons to be suboptimal. Some might even say that “free flaps” indeed really are “free” flaps. Methods A retrospective review of related finances was undertaken for all free flaps performed in a single surgeon private practice during the latest possible year (2014) that included a complete 5-year follow-up to insure receipt of all expected reimbursements from accounts receivable. There were 61 free flaps available; but arbitrarily 12 free flaps were excluded since postmastectomy breast reconstruction always received mandatory insurance payment, as were additional two cases done pro bono as part of an international educational service. This left 47 free flaps to permit determination of gross payments, if any. Results Compensation summated for three distinct time intervals for all free flaps was preoperative: $10,855.92 (mean: $230.98/flap); intraoperative: $117,015.46 (mean: $2,489.69/flap); and postoperative: $45,296.28 (mean: $963.75/flap). Range of gross payment for the free flap portion only was 529.65 to $4,503.71. Total overall revenue received was $173,167.66 (mean: $3,684.42/flap). Conclusion A true benefit cost-analysis even if microsurgery specific expenses could be estimated would be inaccurate, so that mean net income for each free flap could not be determined. Albeit a minimal gross payment was obtained for some free flap procedures, in no instance was there zero reimbursement. Based on that fact, there were no truly “free” free flaps in this private practice experience, which should encourage the younger surgeon to realize that economic viability is possible so that their enthusiasm for reconstructive microsurgery can be sustained.

scholarly journals Profitability of semi-intensive and intensive egg production in South-West and South-South zones of Nigeria.

2006 ◽  
Vol 33 (1) ◽  
pp. 118-127
Author(s):  
V. O. Okoruwa ◽  
A. E. Obuyelu ◽  
O. Ikoyo-Eweto
Keyword(s):  
Egg Production ◽  
Cost Ratio ◽  
Net Income ◽  
The South ◽  
Benefit Cost Analysis ◽  
Benefit Cost Ratio ◽  
Budget Analysis ◽  
South West ◽  
Poultry Farmers ◽  
Benefit Cost

The paper examines the profitability of two improved poultry systems (semi-intensive and intensive egg production system)i in the South-West and South-South zones of Nigeria using descriptive statistics, farm budget analysis approach and the benefit-cost analysis. The data for the study were ob­tained through a multi-stage sapling approach from 70 poultry farmers selected from four states (Edo and Delta in South-South; Lagos and Oyo in the South -West) in the study area. Empirical evidence from the analysis shows that the poultry farmers are predominantly male and mostly single. A greater proportion (80%) of them fell between the ages of 31-50 years and had a least secondary school education. Majority of the farmers (86%) used black nera breed because of its high productiv­ity, resistance to diseases and environmental stress and good quality carcass when disposed as spent layer The study further reveals that differences exist in profitability between the two groups of poultry farmers as the net income of farmers using the battery cage system was about 1.8 times the net income of farmers using deep litter system. However; the benefit-cost ratio indicates that both group of farmers are making profit since the benefit-cast ratio of their poultry business exceed one.

An Analysis of the Private Returns From Three Land Development Options in the Southern Mallee of Nsw.

1999 ◽  
Vol 21 (2) ◽  
pp. 244 ◽  
Author(s):  
DA Patton ◽  
JD Mullen
Keyword(s):  
Land Development ◽  
Net Income ◽  
Benefit Cost Analysis ◽  
The Public ◽  
Public Benefits ◽  
Extensive Grazing ◽  
The Individual ◽  
Western Division ◽  
Benefit Cost ◽  
Benefits And Costs

In early 1993, the DLWC initiated a project to develop regional planning strategies for clearing and cultivation activities in the Southern Mallee and Northern Floodplain areas of the Western Division of NSW. Concentrating on the Southern Mallee region, a benefit-cost analysis of current clearing and cultivation proposals and their impact on the financial viability of the individual landholder has been conducted. While the development proposals all had the potential to return much higher levels of expected net income to farmers than the existing extensive grazing strategy, market and climatic uncertainty meant that the probability of the extensive grazing activity returning more than cropping was as high as 50% for some proposals. This means that farmers have to weigh up higher incomes on average from cropping against the more certain income from grazing. Clearly, this is a personal choice with the more risk averse decision makers favouring the extensive grazing option. However, we found that for levels of risk aversion that research suggests typifies Australian farmers, the development proposals were dominant over the extensive grazing option except where there was a higher proportion of land devoted to conservation at a discount rate of 12%. No attempt has been made in the present study to evaluate the public benefits and costs, in the form of changes in environmental resources, associated with such development proposals Key words: Western Division, conservation, clearing and cultivation, stochastic dominance, economics.

Public Investment Criteria: Benefit-Cost Analysis for Planned Economic Growth by Stephen A. Marglin. London: George Allen & Unwin Ltd., 1967. pp.103. 22s. 6d.********** Investments for Capacity Expansion: Size, Location and Time-Phasing edited by Alan S. Manne. London: George Allen & Unwin Ltd., 1967. pp.239. 45s.Investments for Capacity Expansion: Size, Location and Time-Phasing edited by Alan S. Manne. London: George Allen & Unwin Ltd., 1967. pp.239. 45s.

1967 ◽  
Vol 7 (3) ◽  
pp. 416-420
Author(s):  
Arthur MacEwan
Keyword(s):  
Cost Benefit Analysis ◽  
Public Investment ◽  
Cost Benefit ◽  
Capacity Expansion ◽  
Point Of View ◽  
Systematic Analysis ◽  
Benefit Cost Analysis ◽  
The Government ◽  
The Many ◽  
Benefit Cost

These books are numbers 4 and 5, respectively, in the series "Studies in the Economic Development of India". The two books are interesting complements to one another, both being concerned with the analysis of projects within national plan formulation. However, they treat different sorts of problems and do so on very different levels. Marglin's Public Investment Criteria is a short treatise on the problems of cost-benefit analysis in an Indian type economy, i.e., a mixed economy in which the government accepts a large planning responsibility. The book, which is wholely theoretical, explains the many criteria needed for evaluation of projects. The work is aimed at beginning students and government officials with some training in economics. It is a clear and interesting "introduction to the special branch of economics that concerns itself with systematic analysis of investment alternatives from the point of view of a government".

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