OBJECTIVES: Reconstructive surgery for mandibular defect often requires autologous tissue harvesting. This approach is successful in 95% of cases but is complex. Patient post-operative healthcare use and morbidity is not well characterized. This study was designed to better understand patient presentation and economic outcomes in the commercially-insured population.

METHODS: the Truven Commercial database was queried. All patients with inpatient admissions from 01-01-2007 to most current (up to 09-2017) with concurrent procedure codes for mandibular repair and bone flap/autograft harvesting were identified. All patients had at least 6 months continuous enrollment pre- and 30-days post index. Patient demographics and comorbidities (including Elixhauser Comorbidity Index (ECI)) at time of surgery were identified. All visits post-index were analyzed. Cost of care for the index and post-operative events were adjusted for inflation based on 2016 consumer price index.

RESULTS: 1,426 patients were identified (average age: 26.5, 42.1% pediatric, 46.8% female), of which 273 (19.1%) had a diagnosis for mandibular or mouth-related cancer within the 6 months prior to surgery and 94 (6.6%) had an ECI of 3 or greater. Other frequent comorbidities included chronic pulmonary disease (5.5%) and hypertension (10.1%). Index surgery averaged US$ 41,935 (SD: US$42,337). At 12 months post-index, 16.4% had an all-cause inpatient readmission (6.5% including orthopedic or orthognathic procedures, 9.9% for non-orthopedic treatments), resulting in an average per-person cost of readmission of US$7,019 (SD: $26,581). In the outpatient setting, patients averaged 2.1 visits for orthopedic or post-operative care-related diagnoses or procedures in the 12 months post index, of which 1.6 was for physical therapy or prosthesis management and 0.17 for orthognathic care. Cost of post-operative outpatient care averaged US$1,542 (SD: 4,798) per patient. Total 12-months care thus averaged US$ 50,496 (SD: 73,716).

CONCLUSIONS: Nearly one in six patients with mandibular reconstruction are readmitted for subsequent care in the 12 months post-index.