169. Intermaxillary Fixation in Mandible Fractures: What is the Most Economical Option?

PURPOSE: Intermaxillary fixation (IMF) is conventionally used in the treatment of mandible and other complex facial fractures. Three main IMF systems include self-tapping IMF screws, Erich arch bars (EAB), and hybrid arch bars (HAB); however, each of these systems vary in cost and installation times. The purpose of this prospective study is to perform a cost-analysis of these methods that considers cost of materials, operative room (OR) time, and anesthesia time. We hypothesize that, although arch bars have a considerably lower materials cost, the increased installation time will lead to greater costs in terms of OR time billing, thus offsetting the costs saved in resources. METHODS: This study comprises adult patients who underwent IMF of mandible fractures at a single institution over a 2-year period. Available fixation systems included IMF screws, EAB, or HAB. IMF device was selected based on surgeon preference given the presenting injury. The primary outcome variable was total device installation time in minutes, defined as the time required for the surgeon to fully complete installation of the IMF system. Operative and anesthesia time costs pertaining only to the IMF portion of the procedure were collected and analyzed. Costs were also adjusted to account for OR and anesthesia fees for IMF devices that required removal in the OR. Patient demographics, mechanism of injury, and mandible fracture classification were also recorded. Differences between IMF device groups in terms of costs and installation times were assessed for significance using Kruskal-Wallis tests. RESULTS: Eighteen patients received IMF using self-tapping screws (n=10), EAB (n=3), or HAB (n=5). Average installation time was significantly longer for EAB vs. screws (30.41±8.41 min vs 4.59± 1.26 min; p=8.40E-03) and for EAB vs. HAB (30.41± 8.41 min vs. 5.68 ± 3.60 min; p=2.90E-02). No significant difference was observed between installation time of screws and HAB (p=0.797). Significant differences in device costs existed between all IMF groups (p=2.47E-04), with EABs providing the most economical option ($5.00±0.00), followed by screws ($443±125). HABs offered the most expensive IMF solution ($1284±309). There were no significant differences in complication rates between IMF devices (p=0.636). All EABs necessitated return to the OR for device removal, accruing additional expenses in this IMF category, as opposed to screws (10% requiring OR removal) and HAB (50%). When IMF installation times were adjusted for OR and anesthesia charges and added to the device cost, accounting for OR removal charges, screws were the most economical ($1274±819), followed by HABs ($2895±1226). EABs were the most expensive ($4244±616). Screws were significantly more economical compared to both EABs (p=1.92E-03) and HABs (p=8.50E-03), with no significant difference observed between EABs and HABs (p=0.411). CONCLUSION: While device materials for Erich arch bars have the lowest cost, the operative and anesthesia time required for EAB installation makes this method the most expensive. IMF screws are overall the most cost-effective with no difference in complication rates.