PMID- 29135727
OWN - NLM
STAT- MEDLINE
DCOM- 20180709
LR  - 20221207
IS  - 1536-3732 (Electronic)
IS  - 1049-2275 (Linking)
VI  - 29
IP  - 1
DP  - 2018 Jan
TI  - Comparative Cost Analysis of Single and Mutli-Stage Temporal Deformity Correction 
      Following Neurosurgical Procedures.
PG  - 130-138
LID - 10.1097/SCS.0000000000004107 [doi]
AB  - PURPOSE: Temporal hollowing deformity (THD) is a visible concavity/convexity in 
      the temporal fossa; a complication often seen following 
      neurosurgical/craniofacial procedures. Although numerous techniques have been 
      described, no study to date has shown the healthcare costs associated with 
      temporal hollowing correction surgery. Thus, the purpose here is to compare and 
      contrast the direct costs related to temporal cranioplasty using various methods 
      including: liquid poly-methyl-methacrylate (PMMA) implants with screw fixation, 
      prebent, modified titanium mesh implants, and customized cranial implants (CCIs) 
      with dual-purpose design. Understanding the financial implications related to 
      this frequently encountered complication will help to motivate 
      surgeons/healthcare facilities to better prevent and manage THD. METHODS: This is 
      a single-surgeon, single-institution retrospective review of 23 THD patients 
      randomly selected from between 2008 and 2015. Cost analysis variables include 
      length of hospital stay, facility/professional fees, implant material fees, payer 
      information, reimbursement rate, and net revenue. RESULTS: Of the 23 patients, 
      ages ranged from 23 to 68 years with a mean of 48.3 years (SD 11.6). Within this 
      cohort, 39.1% received dual-purpose PMMA CCIs (CCI PLUS), 17.4% received modified 
      titanium mesh implants, and 43.5% received hand-molded, liquid PMMA implants with 
      screw fixation. Total facility and/or professional charges ranged from $1978.00 
      to $126478.00. Average total facility charges per patient with dual-purpose CCIs 
      were $34775.89 (SD +/- $22205.09) versus $35826.00 (SD +/- $23509.93) for modified 
      titanium mesh implants and $46547.90 (SD +/- 81061.70) for liquid PMMA implants 
      with screws. Mean length of inpatient stay was 5.7 days (SD = 8.1), and did not 
      differ between implant types (P = 0.387). CONCLUSION: Temporal hollowing 
      deformity is an expensive complication post-neurosurgery, and in the most severe 
      form, requires a revision surgery for definitive correction. Therefore, surgeons 
      should take further initiatives to employ reconstructive methods capable of 
      minimizing risk for costly revision surgery, reducing morbidity related to 
      visible deformity and accompanying social stigmata, and improving overall patient 
      satisfaction.
FAU - Asemota, Anthony
AU  - Asemota A
AD  - Department of Plastic and Reconstructive Surgery, The Johns Hopkins University 
      School of Medicine, The Johns Hopkins Hospital, Baltimore, MD.
FAU - Santiago, Gabriel F
AU  - Santiago GF
AD  - Department of Plastic and Reconstructive Surgery, The Johns Hopkins University 
      School of Medicine, The Johns Hopkins Hospital, Baltimore, MD.
FAU - Zhong, Susan
AU  - Zhong S
AD  - Division of Plastic and Reconstructive Surgery, Department of Surgery, University 
      of North Carolina School of Medicine, Chapel Hill, NC.
FAU - Gordon, Chad R
AU  - Gordon CR
AD  - Department of Plastic and Reconstructive Surgery, The Johns Hopkins University 
      School of Medicine, The Johns Hopkins Hospital, Baltimore, MD.
AD  - Department of Neurosurgery, Johns Hopkins University School of Medicine, 
      Baltimore, MD.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - J Craniofac Surg
JT  - The Journal of craniofacial surgery
JID - 9010410
RN  - 0 (Bone Cements)
RN  - 9011-14-7 (Polymethyl Methacrylate)
RN  - D1JT611TNE (Titanium)
MH  - Bone Cements/therapeutic use
MH  - Bone Screws
MH  - Costs and Cost Analysis
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Neurosurgical Procedures/adverse effects/methods
MH  - Patient Satisfaction
MH  - Polymethyl Methacrylate/therapeutic use
MH  - Postoperative Complications/*surgery
MH  - Random Allocation
MH  - *Plastic Surgery Procedures/economics/instrumentation/methods
MH  - *Reoperation/economics/instrumentation/methods
MH  - Retrospective Studies
MH  - *Temporal Bone/injuries/surgery
MH  - Titanium/therapeutic use
MH  - United States
EDAT- 2017/11/15 06:00
MHDA- 2018/07/10 06:00
CRDT- 2017/11/15 06:00
PHST- 2017/11/15 06:00 [pubmed]
PHST- 2018/07/10 06:00 [medline]
PHST- 2017/11/15 06:00 [entrez]
AID - 10.1097/SCS.0000000000004107 [doi]
PST - ppublish
SO  - J Craniofac Surg. 2018 Jan;29(1):130-138. doi: 10.1097/SCS.0000000000004107.