Abstract
3D printing has gained more interest and popularity in the healthcare industry. The improved quality of the application has warranted its use in healthcare. Their scarcity of knowledge on applying knowledge on the application of 3D printing in healthcare The paper focuses on the merits and demerits of the survey and its cost-effectiveness. More focus will be put on its use in the surgical field and its effects on operation time and improved patient outcomes.
Objective
The narrative review describes 3D printing in the surgical field and its impact on patient outcomes and operation time.
Methods
A literature search was done from three medical databases. The databases include Embase, Web of Science, and PubMed. The keywords and mesh word used included additive manufacturing, prototyping, patient-specific, three-dimensional printing, and implants. The study was restricted to the literature printed in English and those published before 2015.
Results
Our search found out that the application fell under three categories: anatomical models (4 papers), custom implants (4papers), and surgical guides (2 articles). Surgical principles and anatomical models reduced operation time, decreased exposure to ionizing radiation due to reduced fluoroscopy use, and improved general patient outcomes. Custom implants improve the accurateness and aesthetic effect. Consultant surgeons reviewed all ten papers.
Conclusion
The technology increases the procedures’ cost except for the complex processes and those performed by less experienced surgeons. More studies need to be done on the use of technology in the other fields of healthcare.
Introduction
3D printing has been widely used in healthcare for various reasons. It creates human cells for use in engineering medicine; it is also known as additive manufacturing. It is an emerging field of medicine capable of improving the diagnostic and treatments in certain medical conditions. For instance, a radiologist can create a replica of a patient’s spine to plan surgery (Lin et al., 2018).
Problem Statement
The technology has been utilized in healthcare and can be used to save the lives of many people. In some surgeries, the guidance requires ionizing radiation, and it increases the time taken to operate, increasing the chances of complications (Samaila et al., 2020). The anatomical defects such as in dentistry and orthopedics require customed prosthetics that can fit accurately. This necessity for clear picturing and enhanced surgical results have produced the emergent of the 3D customed prosthetics, anatomical models, and client-specific guides (Samaila et al., 2020). There is a lack of systematic knowledge on the applicability of 3D printing in healthcare. A review of the available literature is needed to provide more information on the impact of 3D printing on economic and clinical outcomes.
Definition of Terms
The terms used include additive manufacturing, 3D printing, prosthetics, customized models, anatomical models. Additive manufacturing is the same as 3D printing and is the visualization and creation of a replica of the anatomical organ needed for planning surgery. Prosthetics are customed, artificial organs that function the same as the impaired organs. Customized anatomical models are artificial parts of the human body designed as the anatomy to fit accurately.
Significance of the Study and Claim Statement
The study explores the application of 3D printing inpatient care and its effects on economic and clinical outcomes. There is an increased need for 3D printing in healthcare due to the sector technology’s dynamic and changing nature (Samaila et al., 2020). For evidence-based practice, research on 3D printing is critical for safe methods. This study seeks to identify how 3D printing is used in inpatient care.
It identifies the gaps in the care that needs to be filled. It looks at the implications of the technology on the economic and clinical outcomes, which will provide data for proper individual and healthcare budgeting. It informs the healthcare providers of the advances and the steps made in implementing 3D printing. Lastly, it can be used as a foundation for further studies on the same subject and identifying research gaps. Finally, the study can be used as a reference by future scholars and healthcare personnel. The providers can use this study in deciding on the use of 3D in surgeries and the implicated cost.
Background
3D printing allows three-dimensional visualization of objects by use of a printer. It has brought a revolution in healthcare and prototyping and is also being applied in the non-medical fields. This application is critical in spinal surgery, cardiac surgery, maxillofacial, orthopedics, and neurosurgery in healthcare. Physicians have been working with two-dimensional x-rays, CT scans, and MRI to gain sight of the existing pathologies, and this required excellent picturing skills of the doctor. The recent development of the 3D echo, CT, MRI, and x-ray has improved the pathologies’ visualization but lacks tactile features (Levesque et al., 2020). Objects printed in 3D can be used to understand complex cases, teach medical students, and practice some procedures.
Furthermore, some procedure requires a clear vision of the pathologies and the anatomy of the body parts. This involves guidance to avoid complications such as damaging the organs and for an optimal aesthetic outcome. In some cases, the direction requires ionizing radiation in large amounts, which can increase surgical results. This has led to the development of 3D anatomical models, which necessitates implementing the new technology (Levesque et al., 2020). This study gives an overview of applying the application in human medicine and narrows it down to surgery. It will base the findings on the systematic reviews of the related literature from three significant databases. It explores the areas where this application is commonly used and points out its potential merits and demerits. Due to the hospitals’ budgetary pressure and the physicians’ need to improve efficiency, the cost- and cost-effective variable will be included in the analysis. The research questions include
- What are surgical 3D printing applications commonly used in healthcare
- What are the merits, demerits, and cost effects do 3D printing have on medicine in comparison with the usual standard care?
Methods
A literature exploration was conducted on PubMed, Embase, as well as Web of Science. The search words were three-dimensional printing, radio prototyping, 3D applications, additive manufacturing, patient-specific guides, and implants. The papers included were those published in English and between 2015 and 2021. It also included those that had applied 3D in surgical procedures. For more results, Mesh words and Boolean operators. The search resulted in 5828 results in all three databases. They were screened in case of duplication, but none was found.
Screening of the abstracts was done to include papers that are inconsistent with the application. The papers that had non-human subjects and not about applying 3D in the surgical field were disqualified. This created a list of 56 papers that were further revised through applicability to the surgical cases. This left only 26 articles that underwent full-text screening. Further screening of the papers was done for the involvement of surgical treatment in them, which brought them to a total of 10. Lastly, the articles’ methodologies were divided into either Randomized Clinical Trials, quasi-experimental and technical reports. The report retained after review were analyzed. Based on the available literature, impact on the operations, surgical time, the cost-effectiveness was included.
Data Analysis
The number of papers analyzed was 10. The published application of the 3D occurred in the following areas surgical guides, surgical planning models, custom implants, implant shaping model, prosthetic mold, and the patient selection model. Three of the four anatomical model papers reported reduced surgical time and improved patient outcomes, while one paper recorded a statistically insignificant decrease in time. Two custom implant papers indicated reduced patient outcomes and increased cost of care. The other two recorded no difference in patient outcome and cost. The two surgical guides papers reported reduced exposure to ionizing radiation, improved patient results, and no difference in cost.
Results and Discussion
Anatomical Models
These have broad use in the surgical fields; the literature has shown that its use in orthopedics is significant, especially in hip surgeries with better-quality medical results. Cranial fracture studies, especially fractures of the orbits, have demonstrated enhanced effects that have warranted the use of anatomical models before and after surgery to comprehend the pathology better and prevent complications. (Levesque et al., 2020). It has been used to shape the implants before surgery, ensuring that it fits accurately and reduces surgical time.
The studies have shown that the models improved the clinical outcomes and the surgical time in maxillofacial and spinal surgeries (Ganguli et al.,2018). Further, the models can reduce fluoroscopy frequency during spinal surgery, which reduces the exposure to ionizing radiation. In cardiac surgeries such as percutaneous valve implantation, two studies indicated that the models improved patients’ decisions to undergo endovascular surgeries. Although the models can be used independently, the studies showed a tendency to use them with printed guides. Furthermore, anatomical models could be utilized for training medical learners and enhance client communication of the surgical procedure and its implications (Ganguli et al.,2018).
Surgical Guides
They have been incorporated in the spinal, dental, maxillofacial, and orthopedics, with more than half of the selected guides quoting surgical guides 3D printed. The guides were primarily utilized in knee surgery. There is no difference between patient-specific guides and the ordinary ones in knee arthroplasty (Levesque et al., 2020). The complexity of the surgical procedures, together with the low-experienced physician, necessitates surgical guides. These guides reduce the time taken in the surgical procedures and the surgical trays used. A more significant reduction in time was seen in surgeons who had become used to the procedure.
Few studies mentioned that guides do not cover the additional costs used in the procedure, indicating more cost-effectiveness studies (Fan et al., 2020). For cranial and spinal surgery, guides reduced the time taken and improve the outcomes of the patient. Due to the decreased use of fluoroscopy, more than fifty percent of studies minimize radiation exposure. The accuracy of the guide plays a critical role in the outcome of the procedures.
Custom Implants
According to the available evidence, anatomical models could be molded for use as prosthetics in the ear and cranial surgery. Patient-specific 3D models have been used in surgeries involving augmentation of the chin. This resulted in decreased surgical outcomes and enhanced aesthetic outcomes. The studies have suggested the implants can be used in the final printing of the 3D surgical model, mainly in cranial surgery (Levesque et al., 2020). This decreased the operation time and enhanced accuracy while being associated with improved clinical outcomes in most of the literature reviewed. Also, 3D fixation plates and trays fell time and also improves the clinical outcomes. One study indicated the enhanced formation of the bones and angiogenesis when implants were used. However, some studies have shown low aesthetic with 3D printed dentures and other aesthetic effects as the standard implants (Aimar et a., 2019).
General
Since 3D printing is utilized for various medical uses, most of the studies have shown improved outcomes. More than 50% of the investigated studies supported this statement (Abdullah & Reed, 2018). Although reducing the benefits can be considered a benefit, the increased surgical operation time is not required. Studies have emphasized the positive effects of the planning for the surgical procedures, which the anatomical models enhance. More than three-quarters of the literature mentions the decreased radiation, primarily in spine surgeries due to decreased fluoroscopy. Patients can also profit from the application as anatomical models promote their knowledge of the procedure and its pathology. This improves the patient-doctor relationship and patient satisfaction.
The cost-effectiveness of the application is supported by 7% of the reviewed literature. Most of the literature questions the cost-effectiveness of 3D and concludes that it was not cost-effective (Abdullah & Reed, 2018). The complex nature of the circumstances could raise the cost of the surgery procedures. The augmented burden on health care renders it necessary for the scientists to deliberate on the procedure’s economic burden. Also, the budget for 3D printing is determined by the manufacturer. Inexpensive printers may have quality issues, making the manufacturers strive to make quality and standard care.
Conclusion
3D has already been well integrated into medicine and literature. Applications range from the anatomical models for surgical scheduling to the implants and surgical guides used during the surgical procedures. The significant advantage as per the findings of the study includes reduced surgical operation time, reduced exposure to ionizing radiation, and improved medical outcomes. This allows for the conclusion supporting the merits of the technology in healthcare. The increase associated with 3D printing questions its cost-effectiveness, and therefore it is significant to conclude that it increases healthcare costs.
Furthermore, studies have shown that the technology is more advantageous when used in more complex cases and less experienced physicians. Due to the subjective nature of the data, more studies need to be done on the merits of the technology and its impact on patient care. The application’s cost-effectiveness should also be studied from the manufacturer’s point of view to its surgical procedures usage. The study focused on using a surgical procedure, so the research should focus on other healthcare areas and aspects. This study shed light on the importance of technology in patient care and gives an insight into the gaps present in 3D printing for more assignments.
References
Abdullah, K. A., & Reed, W. (2018). 3D printing in medical imaging and healthcare services. Journal of Medical Radiation Sciences, 65(3), 237–239.
Aimar, A., Palermo, A., & Innocenti, B. (2019). The Role of 3D printing in medical applications: A state of the art. Journal of Healthcare Engineering, 2019, 5340616.
Fan, D., Li, Y., Wang, X., Zhu, T., Wang, Q., Cai, H., Li, W., Tian, Y., & Liu, Z. (2020). Progressive 3D printing technology and its application in medical materials. Frontiers in Pharmacology, 11, 122.
Ganguli, A., Pagan-Diaz, G. J., Grant, L., Cvetkovic, C., Bramlet, M., Vozenilek, J., Kesavadas, T., & Bashir, R. (2018). 3D printing for preoperative planning and surgical training: A review. Biomedical Microdevices, 20(3), 65.
Levesque, J. N., Shah, A., Ekhtiari, S., Yan, J. R., Thornley, P., & Williams, D. S. (2020). Three-dimensional printing in orthopedic surgery: a scoping review. EFORT Open Reviews, 5(7), 430–441.
Lin, H. H., Lonic, D., & Lo, L. J. (2018). 3D printing in orthognathic surgery – A literature review. Journal of the Formosan Medical Association = Taiwan Yi Zhi, 117(7), 547–558.
Samaila, E. M., Negri, S., Zardini, A., Bizzotto, N., Maluta, T., Rossignoli, C., & Magnan, B. (2020). Value of three-dimensional printing of fractures in orthopedic trauma surgery. The Journal of International Medical Research, 48(1), 300060519887299.