Comparison of the microvascular anastomotic CouplerTM system with hand-sewn suture for end to end veno-venous anastomosis for head and neck reconstruction with free flap transfer: Medico-economic retrospective case-control study

The aim of this study was to assess the medico -economic impact of the MACD CouplerTM system in comparison with HSA for end to end veno-venous anastomosis during free flap transfer. A retrospective case -control study was performed in an academic institution, from March 2019 through July 2021, to analyze medical and economic outcomes of patients managed for head and neck reconstruction with free flap transfer. 43 patients per group were analyzed. Rates of initial success, re -intervention, complications and flap transfer failure were not different between groups. Use of MACD increased the cost of medical devices between Coupler and Control groups with respectively Keuro 0.7 [0.5; 0.8] and Keuro 0.1 [0.5; 0.8] (p = 0.001) and decreased the cost for operating staff with respectively Keuro 4.0 [3.4; 5.2] and Keuro 5.1 [3.8; 5.4] (p = 0.03). The total management costs were not different between groups with respectively a total median cost of Keuro 18.4 [14.3; 27.2] and Keuro 17.3 [14.1; 23.7] (p = 0.03). In conclusion, the cost of the CouplerTM is significant but is partly offset by the decrease in operating staff costs. The choice of one or the other technique can be left to the discretion of the surgeon.