Sunday, October 10, 2004 - 2:46 PM

Economic Analysis of Open Approach Versus Conventional Methods of Orbitozygomatic Complex Fracture Repair

Marcin Czerwinski, MD, Dimitrios Motakis, and Chen Lee.

Purpose: Over the past two decades, there has been a trend towards more aggressive treatment of craniomaxillofacial fractures, specifically orbitozygomatic complex (OZC) fractures. Whether the increased initial cost associated with the use of ORIF, as compared to Gillies method, is justified in the increasingly cost-conscious health-care system remains to be determined. The objective of the present study was to identify the costs required to return patients sustaining OZC fractures to the same pre-injury facial appearance, using either Gillies method or ORIF. Methods: Retrospective review of medical records of 153 patients who underwent isolated OZC fracture repair was performed. Analysis included costs of primary surgery and any required secondary reconstructive procedures, including: correction of OZC asymmetry and scleral show. Each cost was determined by adding costs of: OR personnel, equipment and hospital stay. Total costs were calculated by summation of primary treatment costs and potential costs of complications multiplied by their incidence. Results: Mean initial cost of ORIF was 1811$, that of Gillies method was 715$. Mean costs of OZC osteotomies and bone grafting to correct asymmetry, and lateral tarsal strip to correct scleral show were 6021$ and 354$, respectively. Using calculated complication rates, total costs equalled 1930$ and 3725$ for ORIF and Gillies method, respectively. Conclusions: This study demonstrates that cost of Gillies method for OZC fracture repair is greater than ORIF because initial inaccuracy leads to subsequent need for expensive reconstructive procedures. From an economic perspective, initially higher expenses should not discourage the use of more extensive techniques of craniomaxillofacial trauma repair.