Submental island flap reconstruction reduces cost in oral cancer reconstruction compared to radial forearm free flap reconstruction: A case series and cost analysis

D. Forner, Timothy James Phillips, M. Rigby, R. Hart, M. Taylor, J. Trites

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background: In Canada, 4,400 cases of oral cancer are diagnosed yearly. Surgical resection is a key component of treatment in many of these cancers. Reconstruction of defects, with the goal of preserving function, is of utmost importance. Several choices are possible for reconstruction of larger defects, including both free and pedicled flaps. Free flap reconstruction is reliable and effective, but requires additional personnel and peri-operative resources. Pedicled flaps remain an important alternative to free flaps, and are less resource intensive. This paper reviews our inaugural experience with the submental island flap (SIF) and compares costs incurred to a matched cohort of oral cancer patients reconstructed with forearm free flaps. Methods: Charts of patients who underwent SIF and RFFF reconstruction from January 1st 2013 to April 1st 2015 were retrospectively examined. Associated costs were obtained via online database and previously reported costs at the study institution. Results: Mean length of ICU stay in glossectomy RFFF reconstruction was 4.7 days. Only one patient required ICU stay for one night in the SIF group. Mean length of hospital stay was not significantly different in SIF patients vs RFFF patients (12.4 vs 15.4 days, p > ;0.05). Mean operative time was significantly lower in the SIF group compared to the RFFF group (347 vs 552 min, p < 0.05). Total mean intraoperative costs were found to be $4780.59 for RFFF operations, versus $2307.94 for SIF. Total mean cost of post-operative stay was $18158.40 in the SIF group and $43617.60 in the RFFF group. Total cost savings were therefore $27931.85 per patient for the SIF group. Conclusions: We have demonstrated the use of the submental island flap as an alternative to radial forearm free flaps, showing both decreased hospital costs and comparable patient outcomes. Pedicled flaps are making a resurgence in head and neck reconstruction, and the submental island flap offers an excellent alternative to more labour intensive and costly free flap alternatives.

Original languageEnglish (US)
Article number124
JournalJournal of Otolaryngology - Head and Neck Surgery
Volume45
Issue number1
DOIs
StatePublished - Feb 5 2016
Externally publishedYes

Fingerprint

Surgical Flaps
Free Tissue Flaps
Mouth Neoplasms
Forearm
Costs and Cost Analysis
Length of Stay
Glossectomy
Cost Savings
Hospital Costs
Operative Time
Canada
Neck

Keywords

  • Cost
  • Free Flap
  • Oral cancer
  • Pedicle Flap
  • Radial Forearm Free Flap
  • Reconstruction
  • Submental Island Flap

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

Cite this

Submental island flap reconstruction reduces cost in oral cancer reconstruction compared to radial forearm free flap reconstruction : A case series and cost analysis. / Forner, D.; Phillips, Timothy James; Rigby, M.; Hart, R.; Taylor, M.; Trites, J.

In: Journal of Otolaryngology - Head and Neck Surgery, Vol. 45, No. 1, 124, 05.02.2016.

Research output: Contribution to journalArticle

@article{3ccb705f9e034037b0cc48d5fbbfdbab,
title = "Submental island flap reconstruction reduces cost in oral cancer reconstruction compared to radial forearm free flap reconstruction: A case series and cost analysis",
abstract = "Background: In Canada, 4,400 cases of oral cancer are diagnosed yearly. Surgical resection is a key component of treatment in many of these cancers. Reconstruction of defects, with the goal of preserving function, is of utmost importance. Several choices are possible for reconstruction of larger defects, including both free and pedicled flaps. Free flap reconstruction is reliable and effective, but requires additional personnel and peri-operative resources. Pedicled flaps remain an important alternative to free flaps, and are less resource intensive. This paper reviews our inaugural experience with the submental island flap (SIF) and compares costs incurred to a matched cohort of oral cancer patients reconstructed with forearm free flaps. Methods: Charts of patients who underwent SIF and RFFF reconstruction from January 1st 2013 to April 1st 2015 were retrospectively examined. Associated costs were obtained via online database and previously reported costs at the study institution. Results: Mean length of ICU stay in glossectomy RFFF reconstruction was 4.7 days. Only one patient required ICU stay for one night in the SIF group. Mean length of hospital stay was not significantly different in SIF patients vs RFFF patients (12.4 vs 15.4 days, p > ;0.05). Mean operative time was significantly lower in the SIF group compared to the RFFF group (347 vs 552 min, p < 0.05). Total mean intraoperative costs were found to be $4780.59 for RFFF operations, versus $2307.94 for SIF. Total mean cost of post-operative stay was $18158.40 in the SIF group and $43617.60 in the RFFF group. Total cost savings were therefore $27931.85 per patient for the SIF group. Conclusions: We have demonstrated the use of the submental island flap as an alternative to radial forearm free flaps, showing both decreased hospital costs and comparable patient outcomes. Pedicled flaps are making a resurgence in head and neck reconstruction, and the submental island flap offers an excellent alternative to more labour intensive and costly free flap alternatives.",
keywords = "Cost, Free Flap, Oral cancer, Pedicle Flap, Radial Forearm Free Flap, Reconstruction, Submental Island Flap",
author = "D. Forner and Phillips, {Timothy James} and M. Rigby and R. Hart and M. Taylor and J. Trites",
year = "2016",
month = "2",
day = "5",
doi = "10.1186/s40463-016-0124-8",
language = "English (US)",
volume = "45",
journal = "Journal of Otolaryngology - Head and Neck Surgery",
issn = "1916-0208",
publisher = "Decker Publishing",
number = "1",

}

TY - JOUR

T1 - Submental island flap reconstruction reduces cost in oral cancer reconstruction compared to radial forearm free flap reconstruction

T2 - A case series and cost analysis

AU - Forner, D.

AU - Phillips, Timothy James

AU - Rigby, M.

AU - Hart, R.

AU - Taylor, M.

AU - Trites, J.

PY - 2016/2/5

Y1 - 2016/2/5

N2 - Background: In Canada, 4,400 cases of oral cancer are diagnosed yearly. Surgical resection is a key component of treatment in many of these cancers. Reconstruction of defects, with the goal of preserving function, is of utmost importance. Several choices are possible for reconstruction of larger defects, including both free and pedicled flaps. Free flap reconstruction is reliable and effective, but requires additional personnel and peri-operative resources. Pedicled flaps remain an important alternative to free flaps, and are less resource intensive. This paper reviews our inaugural experience with the submental island flap (SIF) and compares costs incurred to a matched cohort of oral cancer patients reconstructed with forearm free flaps. Methods: Charts of patients who underwent SIF and RFFF reconstruction from January 1st 2013 to April 1st 2015 were retrospectively examined. Associated costs were obtained via online database and previously reported costs at the study institution. Results: Mean length of ICU stay in glossectomy RFFF reconstruction was 4.7 days. Only one patient required ICU stay for one night in the SIF group. Mean length of hospital stay was not significantly different in SIF patients vs RFFF patients (12.4 vs 15.4 days, p > ;0.05). Mean operative time was significantly lower in the SIF group compared to the RFFF group (347 vs 552 min, p < 0.05). Total mean intraoperative costs were found to be $4780.59 for RFFF operations, versus $2307.94 for SIF. Total mean cost of post-operative stay was $18158.40 in the SIF group and $43617.60 in the RFFF group. Total cost savings were therefore $27931.85 per patient for the SIF group. Conclusions: We have demonstrated the use of the submental island flap as an alternative to radial forearm free flaps, showing both decreased hospital costs and comparable patient outcomes. Pedicled flaps are making a resurgence in head and neck reconstruction, and the submental island flap offers an excellent alternative to more labour intensive and costly free flap alternatives.

AB - Background: In Canada, 4,400 cases of oral cancer are diagnosed yearly. Surgical resection is a key component of treatment in many of these cancers. Reconstruction of defects, with the goal of preserving function, is of utmost importance. Several choices are possible for reconstruction of larger defects, including both free and pedicled flaps. Free flap reconstruction is reliable and effective, but requires additional personnel and peri-operative resources. Pedicled flaps remain an important alternative to free flaps, and are less resource intensive. This paper reviews our inaugural experience with the submental island flap (SIF) and compares costs incurred to a matched cohort of oral cancer patients reconstructed with forearm free flaps. Methods: Charts of patients who underwent SIF and RFFF reconstruction from January 1st 2013 to April 1st 2015 were retrospectively examined. Associated costs were obtained via online database and previously reported costs at the study institution. Results: Mean length of ICU stay in glossectomy RFFF reconstruction was 4.7 days. Only one patient required ICU stay for one night in the SIF group. Mean length of hospital stay was not significantly different in SIF patients vs RFFF patients (12.4 vs 15.4 days, p > ;0.05). Mean operative time was significantly lower in the SIF group compared to the RFFF group (347 vs 552 min, p < 0.05). Total mean intraoperative costs were found to be $4780.59 for RFFF operations, versus $2307.94 for SIF. Total mean cost of post-operative stay was $18158.40 in the SIF group and $43617.60 in the RFFF group. Total cost savings were therefore $27931.85 per patient for the SIF group. Conclusions: We have demonstrated the use of the submental island flap as an alternative to radial forearm free flaps, showing both decreased hospital costs and comparable patient outcomes. Pedicled flaps are making a resurgence in head and neck reconstruction, and the submental island flap offers an excellent alternative to more labour intensive and costly free flap alternatives.

KW - Cost

KW - Free Flap

KW - Oral cancer

KW - Pedicle Flap

KW - Radial Forearm Free Flap

KW - Reconstruction

KW - Submental Island Flap

UR - http://www.scopus.com/inward/record.url?scp=84961904408&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84961904408&partnerID=8YFLogxK

U2 - 10.1186/s40463-016-0124-8

DO - 10.1186/s40463-016-0124-8

M3 - Article

C2 - 26846792

AN - SCOPUS:84961904408

VL - 45

JO - Journal of Otolaryngology - Head and Neck Surgery

JF - Journal of Otolaryngology - Head and Neck Surgery

SN - 1916-0208

IS - 1

M1 - 124

ER -