Bucknor Alexandra, Chattha Anmol, Ultee Klaas, Wu Winona, Kamali Parisa, Bletsis Patrick, Chen Austin, Lee Bernard T, Cronin Claire, Lin Samuel J
Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St., Suite 5A, Boston, MA, 02215, USA.
Erasmus University Rotterdam, Rotterdam, The Netherlands.
Breast Cancer Res Treat. 2017 Sep;165(2):301-310. doi: 10.1007/s10549-017-4315-4. Epub 2017 Jun 20.
Rates of contralateral prophylactic mastectomy (CPM) have increased over the last decade; it is important for surgeons and hospital systems to understand the economic drivers of increased costs in these patients. This study aims to identify factors affecting charges in those undergoing CPM and reconstruction.
Analysis of the Healthcare Cost and Utilization Project National Inpatient Sample was undertaken (2009-2012), identifying women aged ≥18 with unilateral breast cancer undergoing unilateral mastectomy with CPM and immediate breast reconstruction (IBR) (CPM group), in addition to unilateral mastectomy and IBR alone (UM group). Generalized linear modeling with gamma regression and a log-link function provided mean marginal hospital charge (MMHC) estimates associated with the presence or absence of patient, hospital and operative characteristics, postoperative complications, and length of stay (LOS).
Overall, 70,695 women underwent mastectomy and reconstruction for unilateral breast cancer; 36,691 (51.9%) in the CPM group, incurring additional MMHCs of $20,775 compared to those in the UM group (p < 0.001). In the CPM group, MMHCs were reduced in those aged >60 years (p < 0.001), while African American or Hispanic origin increased MMHCs (p < 0.001). Diabetes, depression, and obesity increased MMHCs (p < 0.001). MMHCs increased with larger (p < 0.001) hospitals, Western location (p < 0.001), greater household income (p < 0.001), complications (p < 0.001), and increasing LOS (p < 0.001). MMHCs decreased in urban teaching hospitals and Midwest or Southern regions (p < 0.001).
There are many patient and hospital factors affecting charges; this study provides surgeons and hospital systems with transparent, quantitative charge data in patients undergoing contralateral prophylactic mastectomy and immediate breast reconstruction.
在过去十年中，对侧预防性乳房切除术（CPM）的实施率有所上升；外科医生和医院系统了解这些患者费用增加的经济驱动因素非常重要。本研究旨在确定影响接受CPM和乳房重建患者费用的因素。
对医疗成本和利用项目国家住院样本（2009 - 2012年）进行分析，确定年龄≥18岁、患有单侧乳腺癌且接受单侧乳房切除术加CPM及即刻乳房重建（IBR）的女性（CPM组），以及仅接受单侧乳房切除术和IBR的女性（UM组）。采用伽马回归和对数链接函数的广义线性模型提供与患者、医院和手术特征、术后并发症及住院时间（LOS）的有无相关的平均边际医院费用（MMHC）估计值。
总体而言，70695名女性因单侧乳腺癌接受了乳房切除术和重建；CPM组有36691名（51.9%），与UM组相比，其额外的MMHC为20775美元（p < 0.001）。在CPM组中，年龄>60岁者的MMHC降低（p < 0.001），而非洲裔美国人或西班牙裔血统者的MMHC增加（p < 0.001）。糖尿病、抑郁症和肥胖症会增加MMHC（p < 0.001）。MMHC随着医院规模增大（p < 0.001）、位于西部（p < 0.001）、家庭收入增加（p < 0.001）、出现并发症（p < 0.001）及住院时间延长（p < 0.001）而增加。城市教学医院以及中西部或南部地区的MMHC降低（p < 0.001）。
有许多患者和医院因素影响费用；本研究为外科医生和医院系统提供了接受对侧预防性乳房切除术和即刻乳房重建患者透明、定量的费用数据。
