Abstract: Cost Analysis of Distraction Osteogenesis Versus Conventional Surgery in Le Fort III Surgery for Syndromic Craniosynostosis

Abstract

INTRODUCTION: Midface hypoplasia can be treated using a Le Fort III osteotomy, either via conventional surgery with immediate advancement or distraction osteogenesis to gradually advance the midface. Economic analyses are reported in as few as 0.6 percent of outcome studies in plastic surgery. There is currently no cost-effectiveness data comparing these two modalities in the literature. This study analyzes cost differences between Le Fort III conventional surgery and distraction osteogenesis among pediatric patients with syndromic craniosynostosis. METHODS: Hospital cost-accounting databases were queried for patients undergoing single-stage advancement or distraction osteogenesis from 2007 to 2016. Nominal cost data was adjusted using the Bank of Canada Consumer Price Index. Reported costs represented the full length of stay for all utilization per patient except for anesthesia and surgeon costs (which were equivalent between groups). Parametric and non-parametric tests were used to analyze data. RESULTS: Total costs for single-stage (n=8) were higher than distraction (n=6) (mean $57,825 versus $38,268, p<0.05). ICU costs for single-stage were significantly higher than distraction (mean, $17,746 versus $5,585, p <0.005). Distraction cases had higher OR costs than single stage but the difference was not significant (mean, $12,540 versus $9,696). Length of stay was significantly longer for single-stage patients (mean, 11 days versus 7 days, p<0.05). CONCLUSION: This single-institution retrospective economic analysis indicates conventional Le Fort III is more costly than distraction osteogenesis. Despite higher operating room costs, recovery time led to this cost discrepancy, which is consistent with the theoretical benefits of gradual bony movements being less traumatic. The cost effectiveness ratio adds to comparative analysis of quality outcomes in existing literature and suggests distraction may provide equal clinical outcome for lower cost.