Author/Authors :
Ryan, Justin Phoenix Children’s Hospital - Phoenix - AZ, USA , Plasencia, Jonathan Phoenix Children’s Hospital - Phoenix - AZ, USA , Velez, Daniel Phoenix Children’s Hospital - Phoenix - AZ, USA , Nigro, John J. Phoenix Children’s Hospital - Phoenix - AZ, USA , Pophal, Stephen Phoenix Children’s Hospital - Phoenix - AZ, USA , Frakes, David Arizona State University - Tempe - AZ, USA , Richardson, Randy St. Joseph’s Hospital and Medical Center - Phoenix - AZ, USA
Abstract :
3D printing is an ideal manufacturing process for creating patient-matched models (anatomical
models) for surgical and interventional planning. Cardiac anatomical models have been described in numerous case
studies and journal publications. However, few studies attempt to describe wider impact of the novel planning
augmentation tool. The work here presents the evolution of an institution’s first 3 full years of 3D prints following
consistent integration of the technology into clinical workflow (2012–2014) - a center which produced 79 models
for surgical planning (within that time frame). Patient outcomes and technology acceptance following implementation
of 3D printing were reviewed.
Methods: A retrospective analysis was designed to investigate the anatomical model’s impact on time-based
surgical metrics. A contemporaneous cohort of standard-of-care pre-procedural planning (no anatomical models)
was identified for comparative analysis. A post-surgery technology acceptance assessment was also employed in
a smaller subset to measure perceived efficacy of the anatomical models. The data was examined.
Results: Within the timeframe of the study, 928 primary-case cardiothoracic surgeries (encompassing both CHD
and non-CHD surgeries) took place at the practicing pediatric hospital. One hundred sixty four anatomical models
had been generated for various purposes. An inclusion criterion based on lesion type limited those with anatomic
models to 33; there were 113 cases matching the same criterion that received no anatomical model. Time-based
metrics such as case length-of-time showed a mean reduction in overall time for anatomical models. These reductions
were not statistically significant. The technology acceptance survey did demonstrate strong perceived efficacy.
Anecdotal vignettes further support the technology acceptance.
Discussion & conclusion: The anatomical models demonstrate trends for reduced operating room and case length of
time when compared with similar surgeries in the same time-period; in turn, these reductions could have significant
impact on patient outcomes and operating room economics. While analysis did not yield robust statistical powering,
strong Cohen’s d values suggest poor powering may be more related to sample size than non-ideal outcomes. The
utility of planning with an anatomical model is further supported by the technology acceptance study which
demonstrated that surgeons perceive the anatomical models to be an effective tool in surgical planning for a complex
CHD repair. A prospective multi-center trial is currently in progress to further validate or reject these findings.
Keywords :
Patient outcomes , Congenital heart disease , 3D printing , Retrospective chart review
