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Войти в исследования Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons · 2026
Economic Inefficiency in Maxillary Reconstruction: Patient-Specific Determinants and Implications for Reconstructive Strategy.
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Klausing Anne, Maier Ferdinand, Thol Felix, Far Frederick, Kramer Franz-Josef
Аннотация
BACKGROUND: Maxillary reconstruction after oncologic resection uses substantial hospital resources, but its economic efficiency within diagnosis-related group (DRG)-based reimbursement remains unclear.
PURPOSE: To identify determinants of economic inefficiency after partial maxillectomy.
STUDY DESIGN, SETTING, SAMPLE: This retrospective single-center cohort study was conducted at University Hospital Bonn, Germany, and included patients undergoing partial maxillectomy for malignant tumors between 2010 and 2025. Patients with incomplete records or missing health-economic variables were excluded.
PREDICTOR VARIABLES: Predictor variables were reconstructive strategy (local vs microvascular), age, sex, American Society of Anesthesiologists physical status classification, Charlson Comorbidity Index, and Functional Comorbidity Index.
MAIN OUTCOME VARIABLE: The primary outcome was inpatient economic efficiency, dichotomized as efficient or inefficient. Inefficiency was defined by prolonged hospitalization relative to DRG-specific length of stay targets, exceeding the DRG upper length of stay threshold, or intensive care unit/intermediate care unit utilization beyond reimbursed limits.
COVARIATES: Not applicable. All analyzed variables were incorporated as predictor variables.
ANALYSES: Multivariable logistic regression was used to identify predictors of inpatient economic inefficiency. Decision tree modelling and subject-level counterfactual analysis estimated individualized efficiency probabilities for both reconstructive strategies. Statistical significance was defined as P < .05.
RESULTS: Of 117 eligible patients, 114 (97.4%) were included after 3 exclusions with incomplete data. The sample comprised 65 females (57.0%) and 49 males (43.0%); mean age was 69.1 (SD 14.4) years. Local reconstruction was performed in 70 subjects (61.4%) and microvascular reconstruction in 44 (38.6%). Economic inefficiency occurred in 112 subjects (98.3%), and 19 (16.7%) exceeded the DRG upper length of stay threshold. Intensive care unit/intermediate care overuse occurred in 34 of 70 locally reconstructed subjects (48.6%) and 16 of 44 microvascularly reconstructed subjects (36.4%; P = .2). Subject-level modelling predicted microvascular reconstruction as the economically more efficient strategy in 84.6% of subjects.
CONCLUSIONS AND RELEVANCE: Economic efficiency after maxillary reconstruction was associated with the interaction between patient-specific risk factors and reconstructive strategy rather than surgical complexity alone. In subject-level modelling, microvascular reconstruction was predicted to be the economically more efficient strategy in 84.6% of subjects, suggesting that assumptions regarding the inherent cost-effectiveness of local reconstruction should be reconsidered and may support more efficient resource allocation under DRG-based reimbursement.
PURPOSE: To identify determinants of economic inefficiency after partial maxillectomy.
STUDY DESIGN, SETTING, SAMPLE: This retrospective single-center cohort study was conducted at University Hospital Bonn, Germany, and included patients undergoing partial maxillectomy for malignant tumors between 2010 and 2025. Patients with incomplete records or missing health-economic variables were excluded.
PREDICTOR VARIABLES: Predictor variables were reconstructive strategy (local vs microvascular), age, sex, American Society of Anesthesiologists physical status classification, Charlson Comorbidity Index, and Functional Comorbidity Index.
MAIN OUTCOME VARIABLE: The primary outcome was inpatient economic efficiency, dichotomized as efficient or inefficient. Inefficiency was defined by prolonged hospitalization relative to DRG-specific length of stay targets, exceeding the DRG upper length of stay threshold, or intensive care unit/intermediate care unit utilization beyond reimbursed limits.
COVARIATES: Not applicable. All analyzed variables were incorporated as predictor variables.
ANALYSES: Multivariable logistic regression was used to identify predictors of inpatient economic inefficiency. Decision tree modelling and subject-level counterfactual analysis estimated individualized efficiency probabilities for both reconstructive strategies. Statistical significance was defined as P < .05.
RESULTS: Of 117 eligible patients, 114 (97.4%) were included after 3 exclusions with incomplete data. The sample comprised 65 females (57.0%) and 49 males (43.0%); mean age was 69.1 (SD 14.4) years. Local reconstruction was performed in 70 subjects (61.4%) and microvascular reconstruction in 44 (38.6%). Economic inefficiency occurred in 112 subjects (98.3%), and 19 (16.7%) exceeded the DRG upper length of stay threshold. Intensive care unit/intermediate care overuse occurred in 34 of 70 locally reconstructed subjects (48.6%) and 16 of 44 microvascularly reconstructed subjects (36.4%; P = .2). Subject-level modelling predicted microvascular reconstruction as the economically more efficient strategy in 84.6% of subjects.
CONCLUSIONS AND RELEVANCE: Economic efficiency after maxillary reconstruction was associated with the interaction between patient-specific risk factors and reconstructive strategy rather than surgical complexity alone. In subject-level modelling, microvascular reconstruction was predicted to be the economically more efficient strategy in 84.6% of subjects, suggesting that assumptions regarding the inherent cost-effectiveness of local reconstruction should be reconsidered and may support more efficient resource allocation under DRG-based reimbursement.