Cost-Effectiveness of Simultaneous versus Sequential Surgery in Head and Neck Reconstruction

Objective: To determine whether simultaneous (ablation and reconstruction overlaps by two teams) head and neck reconstruction is cost effective compared to sequentially (ablation followed by reconstruction) performed surgery. Study Design: Case-controlled study. Setting: Tertiary care hospital. Subjects: Oncology patients undergoing free flap reconstruction of the head and neck. Methods: A match paired comparison study was performed with a retrospective chart review examining the total time of surgery for sequential and simultaneous surgery. Nine patients were selected for both the sequential and simultaneous groups. Sequential head and neck reconstruction patients were pair matched with patients who had undergone similar oncologic ablative or reconstructive procedures performed in a simultaneous fashion. A detailed cost analysis using the microcosting method was then undertaken looking at the direct costs of the surgeons, anesthesiologist, operating room, and nursing. Results: On average, simultaneous surgery required 3 hours 15 minutes less operating time, leading to a cost savings of approximately $ 1200/case when compared to sequential surgery. This represents approximately a 15% reduction in the cost of the entire operation. Conclusion: Simultaneous head and neck reconstruction is more cost effective when compared to sequential surgery.