Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1488, Houston, TX, 77030, USA.
Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Breast Cancer Res Treat. 2020 Nov;184(2):345-356. doi: 10.1007/s10549-020-05845-6. Epub 2020 Aug 16.
The use of two operating microsurgeons has been shown to improve the efficiency and reduce the operative duration of microsurgical breast reconstruction (MSBR). However, the impact of this practice on healthcare cost has not been previously assessed. The goal of this study is to query a national claims database to assess complication rates and overall cost in patients undergoing MSBR using co-surgeon (CS) vs. single-surgeon (SS) approach.
The study cohort, extracted from the MarketScan database, included all female patients who underwent MSBR between 2010 and 2017. Our primary outcome measure was the difference in total healthcare cost between the two operative groups while differences in complication rates were secondary outcome measures.
We identified a total of 8680 patients, out of whom 7531 (87%) underwent MSBR with a SS and 1149 (13%) had a CS. Over the study period, the annual incidence rate of MSBR cases using CS increased from 7.2% in 2010 to 23.3% in 2017 (p < 0.001). Following propensity score matching, complications, emergency room visits, readmissions, and reoperations were all similar between the CS and SS groups. The median total healthcare cost was higher for the CS group [US $76,227 (IQR $67,879) vs. $61,340 (IQR $54,318); p < 0.0001], CONCLUSIONS: Use of the CS approach in MSBR has become increasingly prevalent over time. Analyses of a national claims database suggested that the use of CS is a safe option for patients undergoing MSBR. Further research is needed to optimize CS utilization from a costs and outcomes perspective.
已经证明，使用两名手术显微镜医师可以提高效率并缩短显微乳房重建（MSBR）的手术时间。然而，这种做法对医疗保健成本的影响尚未得到评估。本研究的目的是查询全国索赔数据库，以评估使用辅助手术医师（CS）与单手术医师（SS）进行 MSBR 的患者的并发症发生率和总体成本。
研究队列从 MarketScan 数据库中提取，包括所有 2010 年至 2017 年间接受 MSBR 的女性患者。我们的主要观察指标是两种手术组之间总医疗保健成本的差异，而并发症发生率的差异是次要观察指标。
我们共确定了 8680 例患者，其中 7531 例（87%）接受了 SS 的 MSBR，1149 例（13%）接受了 CS。在研究期间，使用 CS 的 MSBR 病例的年发生率从 2010 年的 7.2%增加到 2017 年的 23.3%（p<0.001）。经过倾向评分匹配后，CS 组和 SS 组的并发症、急诊就诊、再入院和再次手术均相似。CS 组的中位数总医疗保健成本较高[CS 组 76227 美元（IQR 67879 美元）比 SS 组 61340 美元（IQR 54318 美元）；p<0.0001]。
随着时间的推移，CS 方法在 MSBR 中的使用变得越来越普遍。全国索赔数据库的分析表明，CS 是 MSBR 患者的安全选择。需要进一步研究从成本和结果的角度优化 CS 的利用。
