American Association of Plastic Surgeons
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Cost Analysis Of Mohs Vs Total Surgical Excision: A Retrospective Review
Sophia Liu, MD1, Prakash Mathew, MD, MBA1, Mahmood Al Bayati, MD1, Seth Spector, MD, FACS2, Seth Thaller, MD, DMD, FACS1.
1University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA, 2Bruce W. Carter VA Medical Center, Miami, FL, USA.

Purpose: Skin cancer risk is elevated in veterans, Caucasians, and males over age 50, who comprise the majority of patients at the Miami VA healthcare system. Treatments include total surgical excision (TSE) with frozen section (FS) or permanent pathology (PS), and Mohs surgery. Our protocol consists of Mohs procedures performed offsite followed by reconstruction at the VA. This retrospective study examines the cost difference between TSE and Mohs surgery. Methods: A retrospective chart review was performed of VA patients who underwent TSE or Mohs surgery between 2017 and 2019. Patients under age 18 or those without malignancy on final pathology were excluded. Patients were subdivided into TSE vs Mohs. Cost per OR minute was determined using published data for similar institutions. Pathology costs were estimated using institution specific Medicare data. T-test was performed using SPSS. Results: Of 130 patients identified, 82 underwent TSE and 48 underwent Mohs with reconstruction. Cost per OR minute for inpatient government owned facilities was $37.94. A flat fee of $1400 for the Mohs surgery was the contracted rate with the offsite institution. Average cost of Mohs surgery with reconstruction was $3534.12. Average cost of TSE with pathology was $2643.85. TSE was significantly more cost efficient than Mohs with reconstruction (p<0.01). Conclusion: At our institution, TSE appears more cost effective than Mohs with subsequent reconstruction. While these are generalized costs, and data specific to our institution, cost efficiency is an important consideration in improving the value of care for VA patients.


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