Introduction: Three-dimensional (3D) printing plays a rapidly expanding role in the field of craniomaxillofacial (CMF) surgery; however, the time and costs required to efficiently utilize this technology are highly variable. To better delineate the temporal and financial resources needed to establish an efficient workflow, we conducted a systematic review and meta-analysis of studies utilizing patient-directed 3D-printed constructs in the setting of CMF surgery. Methods: A systematic review was performed using PubMed, Web of Science, and Embase. In total, 1679 articles were screened and 45 met inclusion criteria. Primary outcomes included the costs of 3D-printed constructs and the time required for virtual surgical planning (VSP), 3D printing, surgery, and hospitalization. Results: The aggregated data assessed 751 patients, 738 surgeries, and 1136 3D-printed constructs. The most common surgical indication was post-neoplastic reconstruction (n = 304), and the most common surgical procedure was mandibular reconstruction (n = 287). Printed constructs were as follows: contour models (44.1%), guides (30.9%), implants (12.5%), splints (12.1%), and prostheses (0.5%). Printing was the longest contributor to the preoperative workflow, averaging 401.6 minutes, while VSP required, on average, only 98.6 minutes. There was no significant difference in VSP time between constructs printed in-house and those contracted from commercial vendors. However, constructs printed in-house were significantly cheaper than those procured from vendors, averaging $252.20 and $2735.50, respectively ( P < .001). Of articles reporting intraoperative time (n = 19), 78.9% reported significant reductions when using 3D-printed constructs. Conclusion: 3D printing, especially in-house workflows, may reduce costs and improve efficiency for CMF surgery.

Background Rates of postmastectomy breast reconstruction have been shown to vary by racial, ethnic, and socioeconomic factors. In this study, we evaluated disparities across pathways toward breast reconstruction. Methods All women who underwent mastectomy for breast cancer at a single institution from 2017 to 2018 were reviewed. Rates of discussions about reconstruction with breast surgeons, plastic surgery referrals, plastic surgery consultations, and ultimate decisions to pursue reconstruction were compared by race/ethnicity. Results A total of 218 patients were included, with the racial/ethnic demographic of 56% white, 28% Black, 1% American Indian/Native Alaskan, 4% Asian, and 4% Hispanic/Latina. The overall incidence of postmastectomy breast reconstruction was 48%, which varied by race (white: 58% vs. Black: 34%; p < 0.001). Plastic surgery was discussed by the breast surgeon with 68% of patients, and referrals were made in 62% of patients. While older age (p < 0.001) and nonprivate insurance (p < 0.05) were associated with lower rates of plastic surgery discussion and referral, it did not vary by race/ethnicity. The need for an interpreter was associated with lower rates of discussion (p < 0.05). After multivariate adjustment, a lower reconstruction rate was associated with the Black race (odds ratio [OR] = 0.33; p = 0.014) and body mass index (BMI) ≥ 35 (OR = 0.14; p < 0.001). Elevated BMI did not disproportionately lower breast reconstruction rates in Black versus white women (p = 0.27). Conclusion Despite statistically equivalent rates of plastic surgery discussions and referrals, black women had lower breast reconstruction rates versus white women. Lower rates of breast reconstruction in Black women likely represent an amalgamation of barriers to care; further exploration within our community is warranted to better understand the racial disparity observed.

Background: Orthognathic surgery is an effective treatment for deformities involving the middle and lower third of the face. While orthognathic surgery has been demonstrated to have potential benefits, patients may be reluctant to proceed due to concerns regarding the outcome of the treatment, possibility of complications, length of hospitalization, and financial costs. This study aimed to determine whether systemic comorbidities as risk factors affect the outcomes, costs, and of surgical management for orthognathic patients. Methods: Patients who underwent orthognathic surgery, maxillary, mandibular, or both were identified from both the National Inpatient Sample (NIS) and the Nationwide Ambulatory Surgery Sample (NASS) Databases. A cross-sectional study was conducted involving patients who underwent orthognathic surgery between the years 2016 and 2018. Data collected included patient age, gender, race, median household income, insurance type, severity of illness, and comorbidities such as obstructive sleep apnea, smoking, hypertension, and diabetes. Multivariable regression was used to characterize the role of insurance status, median household income, comorbidities, and total charges in the inpatient setting versus the outpatient setting. Results: A total of 20 848 patients in the United States who underwent orthognathic surgery involving either single or double-jaw procedures were included. Diabetes ( P < .05), smoking ( P < .015), obesity ( P < .001), and Black race ( P < .001) were significantly associated with greater length of hospitalization. Patients who underwent isolated maxillary orthognathic procedures were less likely to incur increased costs due to obesity as a comorbid condition ( P < .001). Hispanic patients who underwent single-jaw surgeries, either maxillary or mandibular, had 93% increased odds of having higher total charges incurred ( P < .001). Conclusion: Longer hospital stays are associated with more comorbid conditions and more expensive and complex procedures. Comprehensive assessments of patients’ comorbidities may be useful for predicting the length of stay as well as risk stratification in orthognathic surgery.

IntroductionBreast reconstruction plays an important role for many in restoring form and function of the breast after mastectomy. However, rates of breast reconstruction in the USA vary significantly by race, ethnicity and socioeconomic status. The lower rates of breast reconstruction in non-white women and in women of lower socioeconomic status may reflect a complex interplay between patient and physician factors and access to care. It remains unknown what community-specific barriers may be impacting receipt of breast reconstruction.Methods and analysisThis is a mixed-methods study combining qualitative patient interview data with quantitative practice patterns to develop an actionable plan to address disparities in breast reconstruction in the local community. The primary aims are to (1) capture barriers to breast reconstruction for patients in the local community, (2) quantitatively evaluate practice patterns at the host institution and (3) identify issues and prioritise interventions for change using community-based engagement.Ethics and disseminationEthics approval was obtained at the investigators’ institution. Results from both the quantitative and qualitative portions of the study will be circulated via peer-review publication. These findings will also serve as pilot data for extramural funding to implement and evaluate these proposed solutions.