A financial analysis of maxillomandibular fixation versus rigid internal fixation for treatment of mandibular fractures

Purpose: The aim of this study was to compare the cost-effectiveness of man dibular fracture treatment by closed reduction with maxillomandibular fixat ion (CRF) with open reduction and rigid internal fixation (ORIF). Patients and Methods: This was a retrospective study of 85 patients admitte d to the Oral and Maxillofacial Surgery Service at San Francisco General Ho spital and treated for mandibular fractures from January 1 to December 31, 1993. The patients were divided into 2 groups: 1) those treated with CRF an d 2) those treated with ORIF. The outcome variables were length of hospital stay, duration of anesthesia, and time in operating room. The charge for p rimary fracture treatment included the fees for the operation and hospitali zation without any complications. Within the group of 85 patients treated f or mandibular fractures in 1993, 10 patients treated with CRF and 10 patien ts treated with ORIF were randomly selected, and hospital billing statement s were used to estimate the average charge of primary treatment. The averag e charge to manage a major postoperative infection also was estimated based on the billing statements of 10 randomly selected patients treated in 1993 (5 treated with CRF, 5 with ORIF) who required hospital admission for the management of a complication. The average total charge was computed by usin g the average charge for primary treatment plus the incidence of postoperat ive infection multiplied by the average charge for management of that compl ication. Results: Eighty-Eve patients were included in the study. The average charge for primary treatment was $10,100 for the CRF. group and $28,362 for the O RIF group. The average charge for the inpatient management of a major posto perative infection was $26,671 for the CRF group and $39,213 for the ORIF g roup. The average total charge for management of a mandible fracture with C RF was $10,927; the total charge for the ORIF group was $34,636. Conclusion: The results of this retrospective study suggest that the use of CRF in the management of mandibular fractures at our institution provides considerable savings over treatment by using ORIF. The use of ORIF should b e reserved for patients and fracture types with specific indications. (C) 2 000 American Association of Oral and Maxillofacial Surgeons.