Pien Irene, Caccavale Sophia, Cheung Michael C, Butala Parag, Hughes Duncan B, Ligh Cassandra, Zenn Michael R, Hollenbeck Scott T
From the Division of Plastic and Reconstructive Surgery, Duke University Health System, Durham, NC.
Ann Plast Surg. 2016 May;76(5):489-93. doi: 10.1097/SAP.0000000000000339.
Enthusiasm for the deep inferior epigastric artery perforator (DIEP) flap for autologous breast reconstruction has grown in recent years. However, this flap is not performed at all centers or by all plastic surgeons for breast reconstruction, and it is unclear whether practice patterns have measurably changed. This study aimed to (1) evaluate changing trends in breast flap use in the United States in recent years and (2) identify how these trends have affected charges and costs associated with autologous breast reconstruction.
Patients undergoing autologous breast reconstruction [latissimus dorsi (LD), pedicled transverse rectus abdominus myocutaneous (pTRAM), free TRAM (fTRAM), and DIEP] were identified using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database (2009-2011). A total of 19,182 hospital discharges were reviewed. Patient demographics, hospital teaching center status, payer status, length of stay, total charges, and total costs per discharge were reviewed. Statistical analysis was performed using linear regression, t test, and analysis of variance models.
Between 2009 and 2011, the total number of discharges did not change significantly. Patient age distribution was similar for all flap groups. For individual flaps, there was a significant increase in DIEP flaps (P = 0.03), with a decreasing trend for other abdominal-based flaps. The patients receiving DIEP flap breast reconstruction were covered by private insurance at a higher rate than all other flap procedures (P = 0.03), whereas other potential cost determinants did not differ significantly between the groups. The mean charge per flap was $40,704 for LD, $51,933 for pTRAM, $69,909 for fTRAM, and $82,320 for DIEP. The mean cost per flap was $12,017 for LD, $15,538 for pTRAM, $20,756 for fTRAM, and $23,616 for DIEP.
Between 2009 and 2011, the total amount of autologous breast reconstruction discharges was relatively stable, but the number of DIEP flaps increased significantly. Review of the Healthcare Cost and Utilization Project Nationwide Inpatient Sample data shows that, compared with LD, pTRAM, and fTRAM flaps, the DIEP flap is associated with higher charges and costs.
近年来，用于自体乳房重建的腹壁下动脉穿支（DIEP）皮瓣备受关注。然而，并非所有中心或整形外科医生都开展这种皮瓣用于乳房重建，而且实践模式是否有显著变化尚不清楚。本研究旨在：（1）评估近年来美国乳房皮瓣使用的变化趋势；（2）确定这些趋势如何影响与自体乳房重建相关的费用和成本。
利用医疗成本与利用项目全国住院患者样本数据库（2009 - 2011年）识别接受自体乳房重建（背阔肌皮瓣、带蒂腹直肌肌皮瓣、游离腹直肌肌皮瓣和DIEP皮瓣）的患者。共审查了19182份出院记录。对患者的人口统计学特征、医院教学中心状态、付款人状态、住院时间、总费用以及每次出院的总成本进行了审查。使用线性回归、t检验和方差分析模型进行统计分析。
2009年至2011年期间，出院总数无显著变化。所有皮瓣组的患者年龄分布相似。对于单个皮瓣，DIEP皮瓣显著增加（P = 0.03），其他腹部皮瓣呈下降趋势。接受DIEP皮瓣乳房重建的患者由私人保险覆盖的比例高于所有其他皮瓣手术（P = 0.03），而其他潜在成本决定因素在各组之间无显著差异。每个皮瓣的平均费用：背阔肌皮瓣为40704美元，带蒂腹直肌肌皮瓣为51933美元，游离腹直肌肌皮瓣为69909美元，DIEP皮瓣为82320美元。每个皮瓣的平均成本：背阔肌皮瓣为12017美元，带蒂腹直肌肌皮瓣为15538美元，游离腹直肌肌皮瓣为20756美元，DIEP皮瓣为23616美元。
2009年至2011年期间，自体乳房重建出院总量相对稳定，但DIEP皮瓣数量显著增加。对医疗成本与利用项目全国住院患者样本数据的审查表明，与背阔肌皮瓣、带蒂腹直肌肌皮瓣和游离腹直肌肌皮瓣相比，DIEP皮瓣的费用和成本更高。
