(0630) Cost Outcomes of Virtual Surgical Planning in Head and Neck Reconstruction: A Systematic Review

Introduction: Virtual surgical planning (VSP) is an emerging method in head and neck reconstruction with well demonstrated benefits including reduced operating room (OR) time and complications. However, perceived costs associated with VSP compared to traditional unplanned surgical techniques is a barrier to more widespread utilization. The economic viability of VSP is supported with mixed evidence and as such, this review aims to summarize all published economic evaluations related to VSP.

Methods: A structured search was performed in 5 electronic databases: Medline (Ovid), Embase, Cinahl, Scopus, and Cochrane Central databases using search terms including "VSP," "cost," and "head and neck." Studies that performed a cost analysis on VSP in head and neck reconstruction were included. Data regarding VSP workflow, costs, and variables influencing costs were recorded. The findings were synthesized qualitatively. In eligible studies, a non-parametric Mann-Whitney test was used to compare variables influencing cost reduction.

Results: In total, 16 studies met the final inclusion criteria (n = 704). Out of 16, 13 studies found that VSP either generated cost savings or was comparable in terms of cost to traditional unplanned techniques or freehand surgery (FHS). The vast majority of cost savings were generated from reduced OR times (overall mean reduction of 73.8 minutes (p = 0.008)) and length of stay/hospitalization (LOS/LOH) (overall reduction in of 2.1 days (p = 0.25)) in VSP compared to FHS. Greater cost savings were associated with in-house VSP workflows compared to those that are outsourced. In 2 studies, cost effectiveness of VSP was demonstrated through the gain of calculated quality-adjusted life years (QALYs).

Conclusions: The results of our review support the cost saving benefits of VSP compared to traditional unplanned surgery or FHS. This is primarily attributed to decreased OR times and LOS/LOH and can be attenuated depending on VSP workflow. These results may serve as a guide for future implementation of VSP across institutions however more studies are needed to generalize these findings in wider healthcare contexts.