A. Chatterjee1, T. Kosowski2, B. Pyfer2, S. Maddali3, C. Fisher1, J. Tchou1 1University Of Pennsylvania,Surgery,Philadelphia, PA, USA 2Dartmouth Medical School,Surgery,Lebanon, NH, USA 3Maine Medical Center,Portland, MAINE, USA
Introduction:
A variety of options exist in the treatment of the infected vascular groin graft. The vascular and plastic surgery literature report on using the sartorius and rectus femoris flaps as reasonable coverage options. Both flap options incur cost and have variability in success. Given this, our goal was to perform a cost-utility analysis of the sartorius flap versus the rectus femoris flap in the treatment of an infected vascular groin graft.
Methods:
Cost utility methodology involved a literature review compiling outcomes for specific flap interventions, obtaining utility scores for complications to estimate quality adjusted life years (QALYs), accruing costs using DRG and CPT codes for each intervention, and developing a decision tree that could portray the more cost-effective strategy. Complications were divided into major and minor categories with major including graft loss with axillary-femoral bypass, amputation, and death. Minor complications assumed graft salvage after local debridement for partial flap necrosis, seromas and hematomas. The upper limit for willingness to pay was set at $50,000. We also performed sensitivity analysis to check the robustness of our data. Szilyagi III and Samson III and IV grades of infected groin grafts were included in our study.
Results:
Thirty two studies were used pooling 296 patients (234 sartorius flaps, 62 rectus flaps). Decision tree analysis noted that the rectus femoris flap was the more cost-effective option (Figure). It was the dominant treatment option given that it was more clinically effective by an additional 0.30 QALYs with the sartorius flap option costing an additional $2,241.88. A substantial contribution to these results was due to the sartorius flap having a 13.68% major complication rate versus an 8.6% major complication rate for the rectus femoris flap. One-way sensitivity analysis showed that the sartorius flap became a cost-effective option if its major complication rate was less than or equal to 8.89%.
Conclusion:
The rectus femoris flap in the treatment of the infected vascular groin graft is a cost-effective option compared to the sartorius flap.
