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Outpatient Alveolar Bone Grafting

Farber, Scott J. MD; Runyan, Christopher M. MD, PhD; Stern, Marleigh J. BS; Massie, Jonathan P. BS; Alperovich, Michael MD; Flores, Roberto L. MD

doi: 10.1097/SCS.0000000000002899
Original Articles

Purpose: Alveolar bone graft (ABG) has traditionally been performed with a postoperative inpatient stay secondary to donor site pain. Upon transitioning from an open iliac bone harvesting technique to an Acumed trephine, the authors observed that donor site pain was reduced eliminating an inpatient stay. This study examines the cost savings associated with outpatient ABG surgery.

Methods: A retrospective single-institution review was conducted on all patients who had an ABG performed from 2012 to 2015. Patients were categorized based upon hospital stay: inpatient, observation (23-hour), or outpatient. Cost data reported included: total direct cost, total variable direct cost, fixed direct cost, and the sum of total direct costs for both medical/surgical supplies and operating room costs. T tests were used to determine differences in various cost categories between groups of patients.

Results: Sixty-two procedures were performed: 7 procedures were inpatient, 16 observation, and 39 outpatient. The total direct costs averaged $4536 for inpatients, $3222 for the observation group, and $3340 for the outpatient group. Inpatient and outpatient costs were significantly different (P <0.01). Total variable direct costs (P <0.05) and fixed direct costs (P <0.01) were significantly lower in the outpatient/observation group. All costs for the observation group were significantly lower than inpatient costs, but were not significantly different than outpatient costs. There were no readmissions reported.

Conclusions: Cost of an inpatient stay is significantly higher than outpatient or 23-hour observation for ABG procedures. The Acumed trephine technique allows for same-day discharge. In the face of declining reimbursement, safe and cost-efficient treatments are an appealing option.

*Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO

Hansjörg Wyss Department of Plastic Surgery, NYU School of Medicine, New York, NY.

Address correspondence and reprint requests to Roberto L. Flores, MD, Hansjörg Wyss Department of Plastic Surgery, NYU School of Medicine, 307 East 33rd Street, New York, NY 10016; E-mail:

Received 31 January, 2016

Revised 19 March, 2016

Accepted 9 April, 2016

JPM was funded by the Howard Hughes Medical Institute Medical Research Fellowship Program (Grant Number 57008244).

The authors report no conflicts of interest.

© 2016 by Mutaz B. Habal, MD.