An audit of the effectiveness of postoperative radiographs—do they make a difference?

Bali, N; Lopes, Vrishali

doi:10.1016/j.bjoms.2004.03.003

Cited by 19 publications

(15 citation statements)

References 7 publications

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“…All studies assessing data for evaluation of the necessity for taking postoperative radiographs in maxillofacial trauma were included. The search strategy resulted in 6 useful studies 1,2,4,5,7,12 . Three studies were prospective, 4,5,7 two were retrospective 2,12 and one was combined prospective/retrospective 1 .…”

Section: Discussionmentioning

confidence: 99%

“…One study researched solitary mandible fractures, 5 two studied solitary zygomatic bone fractures 4,12 and one study investigated both solitary mandible and solitary zygomatic bone fractures. 2 All types of maxillofacial fractures were analysed by two studies 1,7 . All studies excluded complex craniofacial trauma.…”

Section: Discussionmentioning

confidence: 99%

“…Several reasons are given to justify postoperative radiographic analysis, including evaluation of surgical treatment, detection of defects after surgery before the patient is discharged, registration of the osteosynthesis material for possible removal in the future, and for teaching and judicial reasons 5,7 , but there is little evidence for this justification 1,3,5 .…”

mentioning

confidence: 99%

“…Some studies have stated that for postoperative evaluation of maxillofacial fractures, clinical judgement alone is adequate and taking radiographs is unnecessary [1][2][3]5 . The question remains whether the amount of radiation the patient is exposed to, the extra expense and the possible delay in discharge with radiography can be justified.…”

mentioning

confidence: 99%

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Postoperative radiographs after maxillofacial trauma: Sense or nonsense?

Bergh

Goey

Forouzanfar

2011

International Journal of Oral and Maxillofacial Surgery

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Postoperative radiographs after maxillofacial trauma: Sense or nonsense?

Bergh

Goey

Forouzanfar

2011

International Journal of Oral and Maxillofacial Surgery

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“…The imaging provides a baseline of the repaired fracture's alignment and hardware positioning. 9 Should a complication develop, a simple panorex radiograph can be obtained and com-pared with the baseline radiograph to guide further clinical decision making. A baseline study provides useful information in deciding whether a return trip to the operating room (OR) is necessary.…”

mentioning

confidence: 99%

Cost-Based Decision Analysis of Postreduction Imaging in the Management of Mandibular Fractures

Barrett

Halbert

Fiorillo

et al. 2015

JAMA Facial Plast Surg

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IMPORTANCE Immediate postreduction imaging is a standard practice in the management of mandibular fractures at many hospitals. However, the literature suggests that postreduction imaging in maxillofacial fractures fails to influence clinical decision making significantly. OBJECTIVES To determine the cost-effectiveness of different clinical decision pathways regarding postreduction imaging as it relates to the experience of the surgeon, and to demonstrate that baseline postreduction imaging has utility based on the complication rate of the surgeon. DESIGN, SETTING, AND PARTICIPANTS We developed a decision tree model using commercially available software. The model accounted for cost of imaging modalities, adequacy of reduction, complication rate, cost of initial operating room time, and, if applicable, operative charges for revision surgery in the event of a complication. A review of the University of Virginia clinical data repository of 100 patients with recent mandible fractures was used to estimate the cost associated with running an operating suite for mandibular fracture repair. The University of Virginia billing system also provided costs associated with a single computed tomogram, panoramic radiography, and intraoperative 3-dimensional computed tomography. A sensitivity analysis determined how variation in complication rate affects the cost of the decision pathways. INTERVENTION Intraoperative imaging, postreduction imaging, or no imaging. MAIN OUTCOMES AND MEASURES Sensitivity of the decision tree model to variation in complication rate. RESULTS Using current hospital charges, the model is sensitive to variability in the complication rate with a breakpoint of 17.7%. It is most cost-effective to obtain a post-reduction panorex if the surgeon's complication rate is above 17.7% and most cost-effective not to obtain any postreduction imaging if the complication rate is below 17.7%. Intraoperative computed tomography is not cost-effective at any complication rate. Two-way sensitivity analysis allowed the model to be generalizable to varied institutional costs and surgical complication rates. CONCLUSIONS AND RELEVANCE The utility of postreduction imaging from the standpoint of cost analysis depends on the complication rate of the facial traumatologist and institutional charge data. Based on this model, the facial traumatologist at our institution should obtain postreduction panorex imaging for patients with mandible fractures until their complication rate drops below 17.7%. The 2-way sensitivity analysis in this study allows the facial traumatologist to apply his or her complication rate and institutional cost data to determine whether routine postreduction imaging is necessary. LEVEL OF EVIDENCE NA.

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