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A Nationwide Analysis of Cost Variation for Autologous Free Flap Breast Reconstruction.

ABSTRACT: Importance:Cost variation among hospitals has been demonstrated for surgical procedures. Uncovering these differences has helped guide measures taken to reduce health care spending. To date, the fiscal consequence of hospital variation for autologous free flap breast reconstruction is unknown. Objective:To investigate factors that influence cost variation for autologous free flap breast reconstruction. Design, Setting, and Participants:A secondary cross-sectional analysis was performed using the Healthcare Cost and Utilization Project National Inpatient Sample database from 2008 to 2010. The dates of analysis were September 2016 to February 2017. The setting was a stratified sample of all US community hospitals. Participants were female patients who were diagnosed as having breast cancer or were at high risk for breast cancer and underwent autologous free flap breast reconstruction. Main Outcomes and Measures:Variables of interest included demographic data, hospital characteristics, length of stay, complications (surgical and systemic), and inpatient cost. The study used univariate and generalized linear mixed models to examine associations between patient and hospital characteristics and cost. Results:A total of 3302 patients were included in the study, with a median age of 50 years (interquartile range, 44-57 years). The mean cost for autologous free flap breast reconstruction was $22?677 (interquartile range, $14?907-$33?391). Flap reconstructions performed at high-volume hospitals were significantly more costly than those performed at low-volume hospitals ($24?360 vs $18?918, P?

SUBMITTER: Billig JI

PROVIDER: S-EPMC5710414 | biostudies-literature | 2017 Nov

REPOSITORIES: biostudies-literature

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A Nationwide Analysis of Cost Variation for Autologous Free Flap Breast Reconstruction.

Billig Jessica I JI Lu Yiwen Y Momoh Adeyiza O AO Chung Kevin C KC

JAMA surgery 20171101 11

<h4>Importance</h4>Cost variation among hospitals has been demonstrated for surgical procedures. Uncovering these differences has helped guide measures taken to reduce health care spending. To date, the fiscal consequence of hospital variation for autologous free flap breast reconstruction is unknown.<h4>Objective</h4>To investigate factors that influence cost variation for autologous free flap breast reconstruction.<h4>Design, setting, and participants</h4>A secondary cross-sectional analysis w ...[more]

PMID: 28724133

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Project description:BackgroundThe outcomes of immediate autologous breast reconstruction (IABR) after partial mastectomy followed by postoperative radiotherapy (RT) in terms of aesthetics, treatment-related complications, and local control are unclear. In this study, we evaluated the efficacy of IABR after partial mastectomy with or without breast RT, and thus the impact of radiation on autologous flap transfer.MethodA retrospective cohort study involving consecutive breast cancer patients who underwent IABR after partial mastectomy between July 2011 and December 2017 at Shengjing Hospital was performed. Patients were divided into two groups based on whether or not they received RT after IABR. We compared aesthetic outcomes and changes in the flap size over the three-dimensional coordinates at various timepoints (pre-RT, 1, 6, and 12 months post-RT), as well as postoperative complications, survival, and recurrence rates between the two groups.ResultsIn total, 84 breast cancer patients were enrolled, with 32 patients in the RT group and 52 in the non-RT group. At a median follow-up time of 33.3 months, no significant difference was found in the rate of regional recurrence between the two groups (3.13% vs. 3.85%, P = 1.00), and no local recurrences occurred in either group. At the timepoints pre-RT, 1, and 6 months post-RT (approximately 4, 7, and 12 months after IABR, respectively), 77 (91.7%), 70 (83.3%), and 83 (98.8%) patients, respectively, had achieved very good or good cosmetic outcomes, and only changes in breast skin color at 1 month after RT significantly differed between the RT and non-RT groups, with very good or good cosmetic result rates of 62.5% vs. 96.2%, respectively (P < 0.001). No significant difference in the reduction of flap size was observed at any timepoint between the two groups. There were no significant differences between the two groups in the rates of postoperative complications including necrosis of the flap, infection, hematoma, or seroma (all P > 0.05). Additionally, no grade 3 or greater RT-associated adverse events occurred during or after RT.ConclusionRT following IABR provides aesthetically satisfactory results without intolerable adverse complications and may safely be performed in patients who underwent IABR after partial mastectomy.

Dataset Information

A Nationwide Analysis of Cost Variation for Autologous Free Flap Breast Reconstruction.

Publications

A Nationwide Analysis of Cost Variation for Autologous Free Flap Breast Reconstruction.

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