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A Standardized Care Pathway for Alveolar Bone Grafting Decreases Length of Stay while maintaining Outcomes
Wesley N Sivak, MD, PhD
Catharine B Garland, MD
Michael R Bykowski, MD
Liliana Camison, MD
Jesse A Goldstein, MD
Joseph E Losee, MD
University of Pittsburgh
2016-01-31
Presenter: Wesley Sivak
Affidavit:
The project represents the original work of the resident who was aided in data collection by the coauthors.
Director Name: Joseph E Losee
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Purpose: Patients undergoing alveolar bonegrafting (ABG) experience high levels of pain and prolonged hospital length of stay. This study demonstrates the efficacy of an ABG protocol implementing peri-operative pain control measures.
Methods: Review of our institution's ABG experience with traditional open iliac crest bonegraft (ICBG) versus minimal-access ICBG with peri-operative measures (e.g. – indwelling 0.2% ropivicane pump at harvest site, intraoperative steroids, toradol, IV acetaminophen, and bilateral V2 ropivicaine blockade). All patients (n=47) were treated with alveolar fistula repair with primary closure.
Results: Group 1 consists of the traditional ICBG protocol, 22 patients (12 male/10 female, average age 10.1 yrs) treated between October 2004-December 2006; 17 unilateral and 5 bilateral (n=27). Group 2 consists of the minimal access ICBG protocol, 25 patients (10 male/15 female patients, average age 9.0 yrs) treated between January-August 2015; 18 unilateral and 7 bilateral (n=32). Average follow-up was 82.7 and 0.4 months, respectively. Average operative time/alveolus was 128.7 mins for Group 2 and 180.4 mins for Group 1 (p<0.01). Maximum post-op pain score was 1.8 in Group 2 and 7.25 in Group 1 (p<0.0001). Average hospital stay was 0.5 days for Group 2 and 2.4 days for Group 1 (p<0.0001). No wound infections, bleeding requiring transfusion/reoperation, local anesthetic reactions, or mortalities occurred. Financial analysis demonstrates an average cost-savings of 53.5% under the new protocol.
Conclusions: Our optimized protocol is associated with low morbidity, short operative times, shorter hospital stay, and lower cost compared to patients that have undergone traditional ABG.
