Boston and Burlington, Mass. From the Tufts University School of Medicine; the Harvard Plastic Surgery Program, and the Department of Plastic Surgery; and the Department of Plastic Surgery, Lahey Hospital and Medical Center.
Plast Reconstr Surg. 2014 Apr;133(4):448e-454e. doi: 10.1097/PRS.0000000000000025.
Skin flap necrosis is the most common complication following prosthesis-based breast reconstruction. Many studies have reported on the efficacy of laser-assisted indocyanine green angiography (SPY Elite System) in detecting flap necrosis. A cost-effectiveness analysis of laser-assisted indocyanine green angiography is lacking.
The authors performed a retrospective review of all consecutive immediate postmastectomy prosthesis-based reconstructions at the Brigham and Women's Hospital over a 7-year 10-month period. The rate of mastectomy skin flap necrosis and related implant loss was determined for the entire cohort and for the subgroups of patients at increased risk for developing this complication: smokers, obese patients, and patients with large breasts. Cost of treating implant loss and skin flap necrosis was calculated based on the average treatment courses and costs at the authors' institution. The cost of the SPY was obtained from LifeCell Corp.
From January of 2004 through October of 2011, 79 of 710 prosthesis-based breast reconstructions (11.1 percent) developed mastectomy skin flap necrosis requiring excision and reclosure. Performing laser-assisted indocyanine green angiography on the entire cohort would result in an additional cost of $1537.30 per case of flap necrosis prevented. If laser-assisted indocyanine green angiography was performed on only these high-risk subgroups, the cost savings per case of flap necrosis prevented is $2098.80 for smokers, $5162.30 for patients with a body mass index greater than 30, and $1892.70 for patients with mastectomy weight greater than 800 g.
Laser-assisted indocyanine green angiography is not cost-effective as a preventative measure for flap necrosis if used indiscriminately on all patients undergoing prosthesis-based breast reconstructions, but it is cost-effective for high-risk patients, such as smokers, obese patients, and patients with large breasts.
皮瓣坏死是假体乳房重建术后最常见的并发症。许多研究已经报道了激光辅助吲哚菁绿血管造影（SPY Elite 系统）在检测皮瓣坏死方面的疗效。激光辅助吲哚菁绿血管造影的成本效益分析尚缺乏。
作者对 7 年 10 个月期间在 Brigham and Women's Hospital 进行的所有连续即刻乳房假体重建术进行了回顾性研究。确定了整个队列以及发生这种并发症风险较高的亚组（吸烟者、肥胖患者和乳房较大的患者）的乳房切除术皮瓣坏死和相关植入物丢失的发生率。根据作者所在机构的平均治疗疗程和费用计算了治疗植入物丢失和皮瓣坏死的成本。SPY 的成本从 LifeCell Corp 获得。
从 2004 年 1 月至 2011 年 10 月，710 例假体乳房重建术中有 79 例（11.1%）发生乳房切除术皮瓣坏死，需要切除和重新闭合。对整个队列进行激光辅助吲哚菁绿血管造影，每例皮瓣坏死预防的额外成本为 1537.30 美元。如果仅对这些高危亚组进行激光辅助吲哚菁绿血管造影，每例皮瓣坏死预防的成本节约为吸烟者 2098.80 美元，体重指数大于 30 的患者为 5162.30 美元，乳房切除术重量大于 800 克的患者为 1892.70 美元。
如果对所有接受假体乳房重建术的患者不分青红皂白地使用激光辅助吲哚菁绿血管造影作为预防皮瓣坏死的措施，其并不具有成本效益，但对于高危患者，如吸烟者、肥胖患者和乳房较大的患者，它具有成本效益。
