From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine; the Harvard T. H. Chan School of Public Health; and the Division of Plastic and Reconstructive Surgery, University of Maryland School of Medicine.
Plast Reconstr Surg. 2020 Mar;145(3):499e-506e. doi: 10.1097/PRS.0000000000006545.
Breast reduction mammaplasty is a common plastic surgery operation. Although many contemporary surgeons provide breast reduction mammaplasty as an outpatient procedure, roughly 15 percent of patients are still observed postoperatively. The authors hypothesize that observation confers no safety benefit but engenders significant cost.
The authors reviewed cases of breast reduction mammaplasty in a commercial database and formulated three propensity score-matched cohorts: inpatient, 23-hour observation, and outpatient. Comparisons were made between inpatients and outpatients and between 23-hour observation patients and outpatients. The primary outcome variable was 14-day re-presentation rate to the emergency department or readmission. Financial data were also collected.
Comparison of inpatients and outpatients included 1237 patients each (n = 2474 total patients). The 23-hour observation-outpatient comparison included 8153 patients each (n = 16,306 total patients). For inpatients versus outpatients, the 14-day re-presentation rate was 1.4 percent for inpatients and 0.3 percent for outpatients (p < 0.01). The overall surgical complication rate was higher for inpatients (7.8 percent) than for outpatients (4.9 percent) (p < 0.01). Comparing outpatients to 23-hour observation patients, the 14-day re-presentation rate was similar (0.5 percent observation versus 0.3 percent outpatient; p = 0.10). The complication rate was higher for 23-hour observation patients (4.8 percent) than for outpatients (3.2 percent) (p < 0.01). When compared with outpatients (median, $9077), inpatients (median, $19,975) generated $10,898 more in costs. Similarly, 23-hour observation patients (median, $12,451) generated $4050 more in costs than outpatients (median, $8401) (p < 0.01).
Outpatient breast reduction mammaplasty is equally safe when compared to observation or admission. Non-outpatient breast reduction mammaplasty had median costs of 148 to 220 percent that of outpatient breast reduction mammaplasty. In an era of cost consciousness, ambulatory reduction mammaplasty may offer a relatively simple method of decreasing expenditures.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
乳房缩小成形术是一种常见的整形手术。尽管许多当代外科医生将乳房缩小成形术作为门诊手术，但仍有约 15%的患者需要术后观察。作者假设观察并不能带来安全益处，反而会产生显著的成本。
作者回顾了商业数据库中乳房缩小成形术的病例，并制定了三个倾向评分匹配队列：住院、23 小时观察和门诊。比较了住院患者和门诊患者，以及 23 小时观察患者和门诊患者。主要观察指标是 14 天内因任何原因返回急诊或再次入院的发生率。还收集了财务数据。
住院患者与门诊患者的比较包括每组 1237 例（共 2474 例）。23 小时观察门诊患者的比较包括每组 8153 例（共 16306 例）。对于住院患者与门诊患者，14 天再就诊率分别为住院患者的 1.4%和门诊患者的 0.3%（p<0.01）。住院患者的总体手术并发症发生率（7.8%）高于门诊患者（4.9%）（p<0.01）。与 23 小时观察患者相比，14 天再就诊率相似（0.5%观察与 0.3%门诊；p=0.10）。23 小时观察患者的并发症发生率（4.8%）高于门诊患者（3.2%）（p<0.01）。与门诊患者（中位数为 9077 美元）相比，住院患者（中位数为 19975 美元）增加了 10898 美元的费用。同样，23 小时观察患者（中位数为 12451 美元）比门诊患者（中位数为 8401 美元）增加了 4050 美元的费用（p<0.01）。
与观察或住院相比，门诊乳房缩小成形术同样安全。非门诊乳房缩小成形术的中位费用比门诊乳房缩小成形术高 148%至 220%。在成本意识时代，门诊减少乳房成形术可能是降低支出的一种相对简单的方法。
临床问题/证据水平：治疗性，III 级。
