The Impact of Virtual Surgical Planning on the Value of Orthognathic Surgery for the Maxillofacial Surgeon

FACE ◽  
2021 ◽  
pp. 273250162110019
Author(s):  
Ashley Rogers ◽  
Karina Charipova ◽  
Stephen B. Baker
Keyword(s):  
Breast Reconstruction ◽  
Plastic Surgery ◽  
Orthognathic Surgery ◽  
Planning Process ◽  
Tissue Expander ◽  
Diep Flap ◽  
Muscle Flaps ◽  
Presurgical Planning ◽  
Recent Developments ◽  
The Impact

Background: The practice of orthognathic surgery traditionally involved time-intensive presurgical planning that was associated with decreased compensation relative to other procedures within the specialty. This limited reimbursement and subsequent reduction in the incidence of these procedures has been described in the literature. The introduction of VSP has streamlined the presurgical planning process. The purpose of this study is to provide a reevaluation of the relative value units (RVUs) per unit time for orthognathic surgery and to make a comparison to other commonly performed plastic surgery procedures in the context of recent developments in VSP. Methods: RVU data for both orthognathic and common plastic surgery procedures were collected using Current Procedural Terminology (CPT) codes. A range of operative times was then used to calculate work RVUs per hour of both orthognathic surgery and other procedures commonly performed by plastic surgeons including: unilateral deep inferior epigastric perforator (DIEP) flap breast reconstruction, bilateral breast tissue expander placement, bilateral breast reduction, bilateral breast reconstruction using latissimus dorsi muscle flaps, and panniculectomy. Results: Hourly RVUs for orthognathic procedures compare favorably to hourly RVUs for other commonly performed plastic surgery procedures when examined within a range of expected average operative times. Conclusions: Accounting for the reduced time commitment to preoperative planning that VSP achieves, the authors demonstrate a significant RVU/hour increase in orthognathic procedures than that described in the literature published prior to the implementation of VSP. Orthognathic surgery remains competitive for maxillofacial surgeons when compared to other procedures in plastic surgery when RVUs/hour is the metric of comparison.

How Does Autologous Breast Reconstruction Impact Downtime?

2018 ◽  
Vol 34 (07) ◽  
pp. 530-536 ◽  
Author(s):  
Daniel Rais ◽  
Jian Farhadi ◽  
Giovanni Zoccali
Keyword(s):  
Breast Reconstruction ◽  
Donor Site ◽  
Diep Flap ◽  
Autologous Reconstruction ◽  
Autologous Breast Reconstruction ◽  
Superior Gluteal Artery ◽  
Free Flap Surgery ◽  
Recovery Times ◽  
Time Required ◽  
The Impact

Background Although autologous breast reconstruction is technically quite demanding, it offers the best outcomes in terms of durable results, patient perceptions, and postoperative pain. Many studies have focused on clinical outcomes and technical aspects of such procedures, but few have addressed the impact of various flaps on patient recovery times. This particular investigation entailed an assessment of commonly used flaps, examining the periods of time required to resume daily activities. Methods Multiple choice questionnaires were administered to 121 patients after recovery from autologous reconstruction to determine the times required in returning to specific physical activities. To analyze results, the analysis of variance F-test was applied, and odds ratios (ORs) were determined. Results Among the activities surveyed, recovery time was not always a function of free-flap surgery. Additional treatments and psychological effects also contributed. Adjuvant chemotherapy increased average downtime by 2 weeks, and postoperative irradiation prolonged recovery as much as 4 weeks. Patient downtime was unrelated to flap type, ranging from 2.9 to 21.3 weeks for various activities in question. Deep inferior epigastric perforator (DIEP) flaps yielded the highest OR and transverse upper gracilis (TUG) flaps the lowest. Conclusion Compared with superior gluteal artery perforator and TUG flaps, the DIEP flap was confirmed as the gold standard in autologous breast reconstruction, conferring the shortest recovery times. All adjuvant therapies served to prolong patient recovery as well. Surgical issues, patient lifestyles, and donor-site availability are other important aspects of flap selection.

scholarly journals The Impact of Combined Risk-Reducing Gynecological Surgeries on Outcomes in DIEP Flap and Tissue-Expander Breast Reconstruction

2020 ◽  
Vol 28 (2) ◽  
pp. 112-116
Author(s):  
Avinash P. Jayaraman ◽  
Travis Boyd ◽  
Savannah N. Hampton ◽  
Nicholas T. Haddock ◽  
Sumeet S. Teotia
Keyword(s):  
Breast Reconstruction ◽  
Tissue Expander ◽  
Diep Flap ◽  
Group 4 ◽  
Flap Loss ◽  
Hospital Stays ◽  
Group 3 ◽  
Group 2 ◽  
Risk Reducing ◽  
Group 1

Introduction: In addition to prophylactic mastectomies, BRCA1 and BRCA2 mutation carriers are increasingly choosing to undergo risk-reducing procedures such as hysterectomies and salpingo-oophorectomies. Sometimes these surgeries are performed in the same visit as a mastectomy or a revisionary reconstruction procedure. Literature lacks descriptions of complications and trends for these combined surgeries. Methods: Group 1 patients (n = 10, flaps = 20) had abdominal gynecologic procedures at the time of deep inferior epigastric artery perforator flap (DIEP flap) reconstruction. Group 2 patients (n = 29, breasts = 58) had gynecologic procedures at the time of mastectomy and tissue-expander placement. Group 3 patients (n = 141, breasts = 257) had mastectomy and tissue-expander reconstruction without gynecologic procedures and were used as a control group for group 2. Group 4 patients (n = 357, flaps = 673) had autologous breast reconstruction without gynecologic procedures and were used as a control for group 1. Categorical variables such as complications and flap loss were analyzed using χ2 tests. Continuous variables such as age, body mass index (BMI), operative time, length of stay were analyzed with 2-tailed t tests. Multivariate analyses were run to control for group differences. Results: Groups 1 and 4 were equivalent in age and comorbidities, except group 1 (32.8 kg/m2) had significantly higher BMI than group 4 (31.4 kg/m2), P = .028. Average operating time was statistically equivalent for group 1 patients (610 minutes) and group 4 patients (503 minutes), P = .289. Average hospital stay was equivalent as well (group 1 = 4.4 days, group 4 = 4.1 days, P = .676). Operative times for group 2 patients (457 minutes) were significantly longer than for group 3 patients (288 minutes), P < .01. Group 2 patients (3 nights) had significantly longer hospital stays than group 3 patients (2 nights), P < .01. Group 1 patients (2/20 flaps, 10%) had a significantly higher rate of flap loss than group 4 patients (8/673 flaps, 1%), P < .01. There were no differences in other flap complications. Additionally, there were no significant differences in postoperative tissue-expander complications between group 2 and group 3. Discussion: Both flap losses in Group 1 patients occurred in a single patient with BMI = 39.3 kg/m2 and a personal history of recurrent DVTs. Additionally, the rates of complications across other measures were equivalent between groups. Thus, despite the increased rate of flap loss in Group 1 (10%) vs Group 4 (1.3%), along with the increased operative times and hospital stays, certain patients can be advised that a prophylactic gynecological procedure is safe to combine with breast reconstruction.

scholarly journals Does chemotherapy or radiotherapy affect the postoperative complication in breast cancer patients who underwent immediate breast reconstruction with tissue expander?

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sung Mi Jung ◽  
Byung-Joon Jeon ◽  
Jinsun Woo ◽  
Jai Min Ryu ◽  
Se Kyung Lee ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Postoperative Complications ◽  
Breast Reconstruction ◽  
Cancer Patients ◽  
Tissue Expander ◽  
Immediate Breast Reconstruction ◽  
Breast Cancer Patients ◽  
The Impact ◽  
To Receive

Abstract Background Immediate breast reconstruction with tissue expander in breast cancer patients who were expected to receive adjuvant therapy, such as chemotherapy or radiotherapy, has been a topic of debate. Postoperative complications from tissue expander procedures can delay the timing of adjuvant treatment and subsequently increase the probability of recurrence. The purpose of this study was to identify the impact of chemotherapy and radiotherapy on postoperative complications in patients who underwent immediate reconstruction (IR) using tissue expander. Methods We conducted a retrospective study of 1081 breast cancer patients who underwent mastectomy and IR using tissue expander insertion between 2012 and 2017 in Samsung Medical Center. The patients were divided into two groups based on complications (complication group vs. no complication group). Complication group was regarded to have surgical removal or conservative treatment based on clinical findings such as infection, capsular contracture, seroma, hematoma, rupture, malposition, tissue viability, or cosmetic problem. The complication group had 59 patients (5.5%) and the no complication group had 1022 patients (94.5%). Results In univariate analysis, adjuvant radiotherapy and adjuvant chemotherapy were significantly associated with postoperative complications. In multivariate analysis, however, only higher pathologic N stage was significantly associated with postoperative complications (p < 0.001). Chemotherapy (p = 0.775) or radiotherapy (p = 0.825) were not risk factors for postoperative complications. Conclusions IR with tissue expander after mastectomy may be a treatment option even when the patients are expected to receive adjuvant chemotherapy or radiotherapy. These results will aid patients who are concerned about the complications of IR caused by chemotherapy or radiotherapy determine whether or not to have IR. Trial registration Patients were selected and registered retrospectively, and medical records were evaluated.

Economic Impact of Refinements in ERAS Pathways in DIEP Flap Breast Reconstruction

2021 ◽  
Author(s):  
Pope Rodnoi ◽  
Sumeet S. Teotia ◽  
Nicholas T. Haddock
Keyword(s):  
Breast Reconstruction ◽  
Hospital Length Of Stay ◽  
P Value ◽  
Diep Flap ◽  
Total Cost ◽  
Contribution Margin ◽  
Significant Difference ◽  
Post Hoc ◽  
The Impact ◽  
Operating Suite

Abstract Introduction Enhanced recovery after surgery (ERAS) protocols at our institution have led to an expected decrease in hospital length of stay and opioid consumption for patients treated with deep inferior epigastric perforator (DIEP) flaps for breast reconstruction. We look to examine the economic patterns across these years to see the impact of costs for the patient and institution. Methods This study retrospectively evaluated consecutive patients treated with bilateral DIEP flaps for breast reconstruction between October 2015 and August 2020. We categorized the cases into three categories: pre-ERAS, ERAS, ERAS + bupivacaine. Primary outcomes observed included the contribution margin per operating suite case minute and total cost to the patient. An analysis of variance determined whether there was a difference between the three groups and a Tukey post-hoc analysis made pairwise comparisons. A p-value < 0.05 was significant. Results A total of 268 cases of bilateral DIEPs performed by the two senior authors were analyzed in this study. Seventy-four cases were pre-ERAS, 72 were ERAS, and 122 were ERAS + bupivacaine. There was a statistical difference between the contribution margin per operating minute. A Tukey post hoc test revealed that the average contribution margin per operating suite case minute was significantly higher for the ERAS and ERAS + bupivacaine compared with the pre-ERAS groups.There was a statistically significant difference between the total cost to the patients. A Tukey post hoc test revealed that the average total cost to the patient was statistically significantly lower for the ERAS and ERAS + bupivacaine compared with the pre-ERAS group. Conclusion Implementation of ERAS and continued improvements in ERAS resulted in significantly decreased costs for the patient and increased profitability for the hospital. Investing in improvements to ERAS protocols can improve profitability for the institution while simultaneously improving costs and access to care for patients in need of breast reconstruction.

scholarly journals Does chemotherapy or radiotherapy affect the postoperative complication in patients who underwent immediate breast reconstruction with tissue expander?

2020 ◽  
Author(s):  
Sung Mi Jung ◽  
Byung-Joon Jeon ◽  
Jinsun Woo ◽  
Jai Min Ryu ◽  
Se Kyung Lee ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Postoperative Complications ◽  
Breast Reconstruction ◽  
Capsular Contracture ◽  
Univariate Analysis ◽  
Tissue Expander ◽  
Immediate Breast Reconstruction ◽  
Surgical Removal ◽  
The Impact ◽  
To Receive

Abstract Background: Immediate breast reconstruction with tissue expander in patients who were expected to receive adjuvant therapy, such as chemotherapy or radiotherapy, has been a topic of debate. Postoperative complications from tissue expander procedures can delay the timing of adjuvant treatment and subsequently increase the probability of recurrence. The purpose of this study was to identify the impact of chemotherapy and radiotherapy on postoperative complications in patients who underwent immediate reconstruction (IR) using tissue expander.Methods: We conducted a retrospective study of 1,081 breast cancer patients who underwent mastectomy and IR using tissue expander insertion between 2012 and 2017 in Samsung Medical Center. The patients were divided into two groups based on complications (complication group vs. no complication group). Complication group was regarded to have surgical removal or conservative treatment based on clinical findings such as infection, capsular contracture, seroma, hematoma, rupture, malposition, tissue viability, or cosmetic problem. The complication group had 59 patients (5.5%) and the no complication group had 1,022 patients (94.5%). Results: In univariate analysis, adjuvant radiotherapy and adjuvant chemotherapy were significantly associated with postoperative complications. In multivariate analysis, however, only higher pathologic N stage was significantly associated with postoperative complications (p < 0.001). Chemotherapy (p = 0.775) or radiotherapy (p = 0.825) were not risk factors for postoperative complications.Conclusions: IR with tissue expander after mastectomy may be a treatment option even when the patients are expected to receive adjuvant chemotherapy or radiotherapy. These results will aid patients who are concerned about the complications of IR caused by chemotherapy or radiotherapy determine whether or not to have IR.

The Impact of Breast Mass on Outcomes of Total Skin-Sparing Mastectomy and Immediate Tissue Expander–Based Breast Reconstruction

2015 ◽  
Vol 135 (3) ◽  
pp. 672-679 ◽  
Author(s):  
Frederick Wang ◽  
Michael Alvarado ◽  
Cheryl Ewing ◽  
Laura Esserman ◽  
Robert Foster ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Tissue Expander ◽  
Breast Mass ◽  
The Impact

scholarly journals Postmastectomy Radiation Therapy (PMRT) before and after 2-Stage Expander-Implant Breast Reconstruction: A Systematic Review

Medicina ◽  
2019 ◽  
Vol 55 (6) ◽  
pp. 226 ◽  
Author(s):  
Jeremie D. Oliver ◽  
Daniel Boczar ◽  
Maria T. Huayllani ◽  
David J. Restrepo ◽  
Andrea Sisti ◽  
...  
Keyword(s):  
Systematic Review ◽  
Radiation Therapy ◽  
Breast Reconstruction ◽  
Tissue Expander ◽  
Optimal Timing ◽  
Implant Placement ◽  
Postmastectomy Radiation ◽  
Postmastectomy Radiation Therapy ◽  
The Impact ◽  
Implant Breast Reconstruction

Background: In those undergoing treatment for breast cancer, evidence has demonstrated a significant improvement in survival, and a reduction in the risk of local recurrence in patients who undergo postmastectomy radiation therapy (PMRT). There is uncertainty about the optimal timing of PMRT, whether it should be before or after tissue expander or permanent implant placement. This study aimed to summarize the data reported in the literature on the effect of the timing of PMRT, both preceding and following 2-stage expander-implant breast reconstruction (IBR), and to statistically analyze the impact of timing on infection rates and the need for explantation. Methods: A comprehensive systematic review of the literature was conducted using the PubMed/Medline, Ovid, and Cochrane databases without timeframe limitations. Articles included in the analysis were those reporting outcomes data of PMRT in IBR published from 2009 to 2017. Chi-square statistical analysis was performed to compare infection and explantation rates between the two subgroups at p < 0.05. Results: A total of 11 studies met the inclusion criteria for this study. These studies reported outcomes data for 1565 total 2-stage expander-IBR procedures, where PMRT was used (1145 before, and 420 after, implant placement). There was a statistically significant higher likelihood of infection following pre-implant placement PMRT (21.03%, p = 0.000079), compared to PMRT after implant placement (9.69%). There was no difference in the rate of explantation between pre-implant placement PMRT (12.93%) and postimplant placement PMRT (11.43%). Conclusion: This study suggests that patients receiving PMRT before implant placement in 2-stage expander–implant based reconstruction may have a higher risk of developing an infection.

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