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Comparative analysis of 18-month outcomes and costs of breast reconstruction flap procedures.

Abstract：

BACKGROUND:Data from large-scale studies of breast reconstruction surgery outcomes and downstream costs are lacking. The authors assessed outcomes, patient return rates, and costs across a large, geographically diverse patient population undergoing autologous breast reconstruction. METHODS:Insurance claims for patients undergoing free flap, latissimus dorsi flap, or transverse rectus abdominis myocutaneous (TRAM) flap autologous breast reconstruction were extracted from a U.S. health care database. Claims for an 18-month period after the initial (index) procedure were analyzed to assess episodes of care, complications, breast procedures, and costs. RESULTS:Of 828 patients (274 free flaps, 302 latissimus dorsi flaps, and 252 TRAM flaps), 35 percent experienced postindex complications: incidences related to implant/graft/mesh and hematoma/seroma were highest in the latissimus dorsi arm (19 percent and 6 percent, respectively); the incidence related to breast necrosis was highest in the free flap arm (8 percent); and that related to wound complications was highest in the TRAM arm (6 percent). Returns for complications were 92.7, 84.4, and 115.5 of 100 patients in the free, latissimus dorsi, and TRAM flap arms (p < 0.05, TRAM flap versus other arms), respectively, and 105.5, 116.6, and 87.7 of 100 patients, respectively, for procedures unrelated to complications (p < 0.05, latissimus dorsi versus TRAM flaps). Nearly all patients returned at least once for treatments unrelated to complications. Mean total costs for index surgery plus postindex events were $56,205, $30,783, and $33,380 in the free, latissimus dorsi, and TRAM flap arms, respectively. CONCLUSIONS:Eighteen-month complication and return rates for postindex events were similar across study arms. The frequency of returns and associated cost of procedures unrelated to complications point to the inherently staged nature of autologous breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, III.

journal_name

Plast Reconstr Surg

journal_title

Plastic and reconstructive surgery

authors

Israeli R,Funk S,Reaven NL

doi

10.1097/PRS.0000000000000064

subject

Has Abstract

pub_date

2014-03-01 00:00:00

pages

471-479

issue

eissn

0032-1052

issn

1529-4242

pii

00006534-201403000-00002

journal_volume

133

pub_type

杂志文章

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Comparative analysis of 18-month outcomes and costs of breast reconstruction flap procedures.