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CC BY-NC-ND 4.0 · J Reconstr Microsurg Open 2021; 06(01): e28-e34
DOI: 10.1055/s-0041-1729639
Original Article

The Cost of Care Associated with Microvascular Free Tissue Transfer by Anatomical Region: A Time-Driven Activity-Based Model

Jackson S. Lindell
1   Department of Orthopaedic Surgery, Regions Hospital, St. Paul, Minnesota
,
Breanna L. Blaschke
1   Department of Orthopaedic Surgery, Regions Hospital, St. Paul, Minnesota
2   Department of Orthopaedic Surgery, TRIA Orthopaedic Center, Bloomington, Minnesota
,
Arthur J. Only
3   Department of Orthopaedic Surgery, Methodist Hospital, St. Louis Park, Minnesota
,
Harsh R. Parikh
1   Department of Orthopaedic Surgery, Regions Hospital, St. Paul, Minnesota
4   Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
,
Tiffany L. Gorman
4   Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
,
Sandy X. Vang
1   Department of Orthopaedic Surgery, Regions Hospital, St. Paul, Minnesota
4   Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
,
Ashish Y. Mahajan
1   Department of Orthopaedic Surgery, Regions Hospital, St. Paul, Minnesota
,
Brian P. Cunningham
3   Department of Orthopaedic Surgery, Methodist Hospital, St. Louis Park, Minnesota
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Abstract

Background Microvascular free tissue transfer (FTT) is a reliable method for reconstruction of complex soft tissue defects. The goal of this study was to utilize time-driven activity-based cost (TDABC) accounting to measure the total cost of care of FTT and identify modifiable cost drivers.

Methods A retrospective review was performed on patients requiring FTT at a single, level-I academic trauma center from 2013 to 2019. Patient and surgical characteristics were collected, and six prospective FTT cases were observed via TDABC to collect direct and indirect costs of care.

Results When stratified by postoperative stay at intensive care units (ICUs), the average cost of care was $21,840.22, while cases without ICU stay averaged $6,646.61. The most costly category was ICU stay, averaging $8,310.99 (40.9% of nonstratified overall cost). Indirect costs were the second most costly category, averaging $4,388.07 (21.6% of nonstratified overall cost). Overall, 13 of 100 reviewed cases required some form of revision free-flap, increasing cumulative costs to $7,961.34 for cases with non-ICU stay and $22,233.85 for cases with ICU stay, averaging up to $44,074.07 for patients who stayed in the ICU for both procedures. An increase in cumulative cost was also observed within the timeframe of the investigation, with average costs of $8,484.00 in 2013 compared to $45,128 for 2019.

Conclusion Primary drivers for cost in this study were ICU stay and revision/reoperation. Better understanding the cost of FTT allows for cost reduction through the development of new protocols that drive intraoperative efficiency, reduce ICU stays, and optimize outcomes.

Keywords

free tissue transfer (FTT) - time-driven activity-based cost (TDABC) - indirect costs - direct costs

Financial Disclosure Statement

B.P.C. reports a grant from Integra associated with the conduct of the study; outside the submitted work, wife is CEO and founder of CODE Technology.




Publication History

Received: 15 December 2020

Accepted: 15 February 2021

Article published online:
15 June 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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