DISCLAIMERS

contact us >>

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.

Ohio,Pennsylvania,West Virginia,Indiana,Kentucky,Pennsylvania American Society of Plastic Surgeons

OVSPS Conference