From the Department of Plastic Surgery, Division of Surgery, The University of Texas M. D. Anderson Cancer Center.
Plast Reconstr Surg. 2022 Aug 1;150(2):279e-289e. doi: 10.1097/PRS.0000000000009316. Epub 2022 Jun 3.
Length of stay can have a large impact on overall surgical costs. Several studies have demonstrated that a shortened length of stay is safe and effective after microvascular breast reconstruction. The optimal length of stay from a cost-utility perspective is not known.
The authors used a decision tree model to evaluate the cost-utility, from the perspective of the hospital, of a variety of length-of-stay strategies. Health state probabilities were estimated from an institutional chart review. Expected costs and quality-adjusted life-years were assessed using Monte Carlo simulation and sensitivity analyses.
Over a 10-year period, the authors' overall flap loss and take-back rates were 1.6 percent and 4.9 percent, respectively. After rollback, a 3-day length of stay was identified as the most cost-effective strategy, with an expected cost of $41,680.19 and an expected health utility of 25.68 quality-adjusted life-years. Monte Carlo sensitivity analysis confirmed that discharge on postoperative day 3 was the most cost-effective strategy in the majority of simulations when the willingness-to-pay threshold varied from $50,000 to $130,000 per quality-adjusted life-year gained.
This cost-utility analysis suggests that a 3-day length of stay is the most cost-effective strategy after microvascular breast reconstruction.
住院时间的长短会对整体手术成本产生重大影响。多项研究已经证实，在接受微血管乳房重建手术后，缩短住院时间是安全且有效的。但从成本效益的角度来看，最佳的住院时间尚不清楚。
作者使用决策树模型，从医院的角度评估了各种住院时间策略的成本效益。健康状态概率是根据机构图表回顾进行估计的。使用蒙特卡罗模拟和敏感性分析来评估预期成本和质量调整生命年。
在 10 年期间，作者的整体皮瓣失活和皮瓣回收率分别为 1.6%和 4.9%。在回溯后，3 天的住院时间被确定为最具成本效益的策略，预计成本为 41680.19 美元，预期健康效用为 25.68 个质量调整生命年。蒙特卡罗敏感性分析证实，当每获得一个质量调整生命年的意愿支付阈值在 50000 美元至 130000 美元之间变化时，在大多数模拟中，术后第 3 天出院是最具成本效益的策略。
这项成本效益分析表明，在微血管乳房重建后，3 天的住院时间是最具成本效益的策略。
