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348 COST ANALYSIS OF SELF-INFLICTED FACIAL GUNSHOT WOUNDS: A CASE SERIES.
  1. C. D. Knotts1,
  2. J. D. Wagner1,
  3. H. Brock1
  1. 1University of New Mexico, Albuquerque, NM.

Abstract

Purpose There are numerous studies on the topic of maxillofacial trauma, with focuses spanning from demographics to associated findings and related injuries; however, no study has yet specifically tackled the cost of maxillofacial trauma resulting from facial gunshot wounds. Recent technological advances have led to more aggressive and costly management of these injuries, but treatment protocols based on suitable outcomes have yet to be established. We aim to elucidate the significant expense of these injuries, paying particular attention to those requiring follow-up care and reconstructive surgery.

Methods A total of 55 patients were identified at UNM Hospital (UNMH) from January 1995 to May 2004 by first searching for diagnostic codes related to facial trauma and then reviewing those charts individually. Each patient was cross-referenced in the UNMH billing database and the University Physician Associates (UPA) billing database. Forty-three patients had at least one entry in each database. Only billing entries related to the facial gunshot wound were included for final cost analysis. Demographic data included mean age 34 years, 95% male, and 33% privately insured.

Results Total cost refers to UNMH plus UPA billing. The mean total cost was $76,640.67 per patient (n = 43). The highest total cost for any one patient was $352,158.52, and the lowest cost for an individual was $38,610.54. The mean total cost for patients who had at least one entry in either database at least 1 month from the time of injury was $119,832.57 (n= 22). The highest mean total cost for any patient in this population was $352,158.52. The lowest was $5,885.08.

Conclusions Total cost of self-inflicted facial gunshot wounds is significant, with a mean per patient cost of over $75,000. Patients who remained at UNMH for follow-up care-determined as those with at least one billing entry 30 days from the incident-had a total mean per patient cost of nearly $120,000-a 56% increase. This figure is more impressive considering that some of these patients are still being treated. When the results of this study are weighed with patient insurance demographics of only one-third having private insurance, it becomes apparent that state and federal entities shoulder a significant portion of the cost of managing self-inflicted facial gunshot wounds. Based on the numbers revealed in this paper, open discussion and further research-including outcome studies comparing more expensive and often cosmetic procedures to functionally based interventions-are warranted.

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