Cost Associated with Mandible Fractures Treated with Open Reduction Internal Fixation Across Different Surgical Services at VCU Health Hospital

The purpose of this study is to compare and contrast the cost of treatment of isolated mandibular fractures treated with open reduction at the VCU Health Hospital by the Oral & Maxillofacial surgery, Plastic surgery, and Otolaryngology (ENT) services.

The records of all patients treated for mandibular fractures at the VCU Health Hospital between January 2010 and February 2014 were reviewed and 583 cases were found. In order to best determine the difference in costs of treatment among the treating services, only patients who had mandibular fractures treated on an outpatient basis (discharged on the day of surgery) by open reduction and internal fixation (ORIF) were then selected. Patients who had closed reduction, subcondylar or comminuted mandibular fractures, polytrauma (other systems involved), complicated systemic comorbidities or hospital stays exceeding 1 day were excluded from this study. 185 cases were found to fit the inclusion criteria. These patients were then separated into two groups based on whether a single anatomic site or more than one anatomic site was treated. The total cost of treatment of each patient was based on the initial hospitalization and other associated costs, (anesthesia, plates, screws, and other hardware, surgical supplies, and other operating room expenses). The cost of follow-up, any additional procedures including removal of arch bars, or treatment of postoperative complications was not included. 

There were a total of 102 patients that underwent ORIF of their single site mandibular fracture (angle, body, ramus), and 83 patients that underwent ORIF of mandibular fracture with more than one site (angle, body, ramus included in this study. For single site mandibular fractures, the mean cost per service was $6,444.27 for OMFS, $7,468.84 for Plastic surgery, $7,816.46 for ENT. For mandibles with more than one fracture site the mean cost per service was $7,783.48 for OMFS, $9,378.81 for Plastics, and $15,037.71 for ENT. Overall, there was a difference of 21.3% across the three services in associated repair cost for single site mandibular fractures, and 93.2% across the three services for mandibles with more than one fracture site. The differences in cost were not specifically analyzed, but most likely due to operating room time and materials used during surgery.

The findings of this study suggest that the cost of repair of isolated mandibular fractures depends on which surgical services provides treatment. Specifically, for both single site and multiple site mandibular fractures, the average treatment cost was highest in the ENT department. However, this data accounts for only portion of all mandibular fractures treated at VCU Health Hospital, and even smaller percentage of all facial fractures treated at VCU Health Hospital and nationwide. If these findings can be extrapolated to nationwide differences, among different surgical services using similar treatment modalities, further review might be warranted to evaluate surgical techniques, supply usage, and perhaps additional training for calibration of treatment modalities. This could result in substantial savings to the hospital where these patients are treated and to health care cost in general.

--

Dillon JK, Christensen B, Mcdonald T, Huang S, Gauger P, Gomez P. The financial burden of mandibular trauma. J Oral Maxillofac Surg. 2012;70(9):2124-34.

Pena I, Roberts LE, Guy WM, Zevallos JP. The cost and inpatient burden of treating mandible fractures: a nationwide inpatient sample database analysis. Otolaryngol Head Neck Surg. 2014;151(4):591-8.