Department of Surgery, University of Chicago Medical Center, Chicago, Illinois 60637, USA.
J Reconstr Microsurg. 2011 Oct;27(8):487-94. doi: 10.1055/s-0031-1284234. Epub 2011 Jul 22.
Free flap monitoring typically requires specialized nursing that can increase medical costs. This study uses near-infrared spectroscopy (NIRS) tissue oximetry to monitor free tissue breast reconstruction. We hypothesize this practice will reduce medical costs by eliminating the need for specialized nursing. From August 2006 to January 2010, women undergoing unilateral free tissue breast reconstruction were enrolled and admitted postoperatively to either the surgical intensive care unit (ICU) or floor. Each underwent continuous monitoring using NIRS tissue oximetry and intermittent clinical examination with surface Doppler ultrasonography. Patient demographics, comorbidities, perioperative details, and financial data were recorded. There were 50 patients studied, all with abdominal-based flaps (25 per group). There were no statistically significant differences in patient demographics, comorbidities, mean flap weight, ischemia time, or length of stay between the ICU and floor groups. Four flaps had vascular complications, all detected by NIRS tissue oximetry. Comparison of hospital costs showed an average reduction of $1937 per patient when monitored on the surgical floor (P = 0.036). NIRS tissue oximetry is a sensitive and reliable monitoring tool, eliminating the need for specialized nursing care. The effect is decreased cost structure and increased hospital contribution margin for autologous free tissue breast reconstruction.
游离皮瓣监测通常需要专业的护理，这会增加医疗成本。本研究采用近红外光谱（NIRS）组织血氧测定仪对游离组织乳房重建进行监测。我们假设，通过消除对专业护理的需求，这种做法将降低医疗成本。2006 年 8 月至 2010 年 1 月，对接受单侧游离组织乳房重建的女性进行了前瞻性研究，并在术后将其收入外科重症监护病房（ICU）或病房。所有患者均接受了连续 NIRS 组织血氧测定仪监测和间歇性临床检查及表面多普勒超声检查。记录了患者的人口统计学、合并症、围手术期细节和财务数据。共研究了 50 例患者，均采用腹部皮瓣（每组 25 例）。ICU 组和病房组患者的人口统计学、合并症、平均皮瓣重量、缺血时间或住院时间无统计学差异。4 例皮瓣发生血管并发症，均通过 NIRS 组织血氧测定仪检测到。对住院费用的比较显示，在外科病房监测时，每位患者的平均费用降低了 1937 美元（P = 0.036）。NIRS 组织血氧测定仪是一种敏感可靠的监测工具，可消除对专业护理的需求。其效果是降低了成本结构，增加了自体游离组织乳房重建的医院贡献边际。
