Cai Yida, Boas Samuel R, Summerville Lesley, Kumar Anand
From the Case Western Reserve University School of Medicine.
Department of Plastic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH.
Ann Plast Surg. 2020 Jul;85(S1 Suppl 1):S135-S140. doi: 10.1097/SAP.0000000000002324.
There is significant cost variation among patients undergoing autologous free flap breast reconstruction. Previous studies hypothesize that factors like length of stay and hospital volume are key drivers of cost; however, how these factors have affected cost have not been well studied. Our study analyzes the factors influencing hospital charges relating to these procedures and their trends over a multiyear time frame.
The Healthcare Cost and Utilization Project's National Inpatient Sample database was analyzed from January 2009 to December 2014. All female patients who were diagnosed with breast cancer or at a high risk for breast cancer who underwent autologous free flap breast reconstruction were included. Variables of interest included demographic data, hospital characteristics, hospitalization data, and total hospital charges. Univariate and generalized linear models were used to examine associations between selected variables and the hospitalization charges, as well as trends in these factors over the years included.
There were 659,220 female patients diagnosed with breast cancer or had a high risk of breast cancer between 2009 and 2014. Of these patients, 20,050 (3.0%) received autologous free flap breast reconstruction and were included. The mean total hospital charge was US $98,839.33 (SD = US $61,532.04). Regression analysis showed that the proportion of procedures to the total population of potential patients significantly increased over the selected time frame (P = 0.02). The average total charges also increased significantly (P < 0.01), despite a decrease in length of stay (P = 0.05). Procedures performed in the west were associated with significantly higher charges when compared with other regions (US $147,855.42, P < 0.001). Higher hospital charges were also associated with urban hospitals, regardless of teaching status.
The overall demand for the autologous free flap breast reconstruction is increasing within the patient population, in conjunction with increasing associated hospital charges. This increase in cost is seen despite an overall decrease in length of stay, originally thought to be the main contributor to regional cost variation. Further studies should be done to develop strategies to better target increased hospitalization charges, because the overall health care burden of this procedure is expected to rise if current trends continue.
接受自体游离皮瓣乳房重建的患者之间存在显著的费用差异。以往研究推测，住院时间和医院规模等因素是费用的关键驱动因素；然而，这些因素如何影响费用尚未得到充分研究。我们的研究分析了与这些手术相关的医院收费影响因素及其在多年时间框架内的趋势。
对2009年1月至2014年12月期间医疗成本与利用项目的全国住院患者样本数据库进行分析。纳入所有被诊断为乳腺癌或有乳腺癌高风险且接受自体游离皮瓣乳房重建的女性患者。感兴趣的变量包括人口统计学数据、医院特征、住院数据和医院总收费。使用单变量和广义线性模型来检验选定变量与住院费用之间的关联，以及这些因素在纳入年份中的趋势。
2009年至2014年期间，有659,220名女性患者被诊断为乳腺癌或有乳腺癌高风险。其中，20,050名（3.0%）接受了自体游离皮瓣乳房重建并被纳入研究。医院总收费平均为98,839.33美元（标准差=61,532.04美元）。回归分析表明，在选定的时间框架内，手术在潜在患者总数中的比例显著增加（P = 0.02）。尽管住院时间有所缩短（P = 0.05），但平均总收费也显著增加（P < 0.01）。与其他地区相比，西部地区进行的手术收费显著更高（147,855.42美元，P < 0.001）。无论教学状态如何，城市医院的收费也更高。
在患者群体中，自体游离皮瓣乳房重建的总体需求在增加，同时相关的医院收费也在增加。尽管住院时间总体上有所缩短，而住院时间原本被认为是区域费用差异的主要因素，但费用仍出现了这种增加。如果当前趋势持续下去，由于该手术的总体医疗负担预计会上升，因此应进一步开展研究以制定策略，更好地应对住院费用的增加。
