(A656) Value of Virtual Surgical Planning: Time-Driven Cost Analysis in Head and Neck Osseous Reconstruction

Monday, October 13, 2025

12:00 PM - 1:00 PM EDT

Location: OTO EXPO, Posters

Presenting Author(s)

Arjun Dinesh, MS

Medical Student
Case Western Reserve School of Medicine
Northville, Michigan, United States

Co-Author(s)

KM

Kelly Michele Malloy, MD, MBA, FACS

Professor of Otolaryngology-Head and Neck Surgery
University of Michigan
Ann Arbor, Michigan, United States
KC

Keith A. Casper, MD

Associate Professor of Otolaryngology-Head and Neck Surgery
University of Michigan, United States
MH

Molly Heft Neal, MD

Assistant Professor of Otolaryngology-Head and Neck Surgery
University of Michigan, United States
CS

Chaz Stucken, MD

Associate Professor of Otolaryngology-Head and Neck Surgery
University of Michigan
Ann Arbor, Michigan, United States
SC

Steven Chinn, MD, MPH, FACS

Associate Professor of Otolaryngology-Head and Neck Surgery
University of Pittsburgh
Pittsburgh, Pennsylvania, United States
DF

David WA Forner, MD MSc FRCSC

Assistant Professor of Otolaryngology-Head and Neck Surgery
University of Michigan
Ann Arbor, Michigan, United States

Senior Author(s)

PY

Pratyusha Yalamanchi, MD, MBA

Assistant Professor of Otolaryngology-Head and Neck Surgery
University of Michigan
Ann Arbor, Michigan, United States

Disclosure(s):

Arjun Dinesh, MS: No relevant relationships to disclose.

Kelly Michele Malloy, MD, MBA, FACS: No relevant relationships to disclose.

David WA Forner, MD MSc FRCSC: No relevant relationships to disclose.

Introduction: The cost-effectiveness of virtual surgical planning (VSP) compared to conventional head and neck osseous reconstruction is debated. Here, we apply time-driven activity-based costing (TDABC) to assess the value of VSP in head and neck oncologic procedures.

Methods: A retrospective 1:1 matched cohort analysis of patient demographics, comorbidities, and surgical indications was performed, evaluating head and neck oncologic procedures involving osseous free flap reconstruction at an academic tertiary care center (2018–2020, n=56). TDABC methodology measured resource utilization and cost. Outcomes included operative/ischemia time, postoperative complications (e.g., flap compromise), oncologic margin status, and long-term surgical plate removal at the last follow-up (2024). Univariable and multivariable analyses assessed VSP's impact on outcomes and costs.

Results: There was no significant difference in operative time between VSP and conventional maxillary or mandibular reconstruction in multivariable analysis (p=0.25). Though VSP was significantly associated with more osteotomies compared to conventional osseous reconstruction in multivariable analysis (p=0.027), there was no significant difference in ischemia time between VSP and conventional cases (p=0.61). There were no significant differences in postoperative complication rates (p=0.23) or long-term surgical plate removal (p= 0.42) between VSP and conventional cases in univariable analyses. The total cost of care delivery was $40,500+/-15,400 for the VSP cohort versus $38,600+/-21,860 for conventional reconstruction (p=0.15). While VSP was not a significant driver of the overall cost of care, shorter operative time contributed to the overall cost (p < 0.05). Other cost drivers identified using a generalized linear mixed model included length of stay, return trips to OR, and number of free flaps (R2=0.73).

Conclusions: This is the first study using TDABC to evaluate VSP, highlighting its potential to reduce ischemia time in complex osseous reconstruction without significantly increasing overall care costs.