Department of BioSurgery and Surgical Technology, Imperial College London, London, UK.
Breast Unit, Imperial College Healthcare NHS Trust, London, UK.
BJS Open. 2022 May 2;6(3). doi: 10.1093/bjsopen/zrac073.
Following therapeutic mammoplasty (TM), the contralateral breast may require a later balancing procedure to optimize shape and symmetry. The alternative is to offer patients simultaneous TM with immediate contralateral symmetrization via a dual-surgeon approach, with the goal of reducing costs and minimizing the number of subsequent hospital appointments in an era of COVID-19 surges. The aim of this cost-consequence analysis is to characterize the cost-benefit of immediate bilateral symmetrization dual-operator mammoplasty versus staged unilateral single operator for breast cancer surgery.
A prospective single-centre observational study was conducted at an academic teaching centre for breast cancer surgery in the UK. Pseudonymized data for clinicopathological variables and procedural care information, including the type of initial breast-conserving surgery and subsequent reoperation(s), were extracted from the electronic patient record. Financial data were retrieved using the Patient-Level Information and Costing Systems.
Between April 2014 and March 2020, 232 women received either immediate bilateral (n = 44), staged unilateral (n = 57) for breast cancer, or unilateral mammoplasty alone (n = 131). The median (interquartile range (i.q.r.)) additional cost of unilateral mammoplasty with staged versus immediate bilateral mammoplasty was €5500 (€4330 to €6570) per patient (P < 0.001), which represents a total supplementary financial burden of €313 462 to the study institution. There was no significant difference between groups in age, Charlson comorbidity index, operating minutes, time to adjuvant radiotherapy in months, or duration of hospital stay.
Synchronous dual-surgeon immediate bilateral TM can deliver safe immediate symmetrization and is financially beneficial, without delay to receipt of adjuvant therapy, or additional postoperative morbidity.
在进行治疗性乳房成形术（TM）后，对侧乳房可能需要进行后续的平衡手术，以优化形状和对称性。另一种选择是通过双手术医生的方法为患者提供同时的 TM，并立即进行对侧对称化，以在 COVID-19 激增的时代降低成本并最大限度地减少后续的医院预约次数。本成本效益分析旨在描述即时双侧对称化双手术医生乳房成形术与分期单侧单手术医生乳房癌手术的成本效益。
在英国的一家学术乳腺癌手术教学中心进行了前瞻性单中心观察性研究。从电子患者记录中提取了包括初始保乳手术类型和随后的再手术等临床病理变量和手术护理信息的假名数据。使用患者层面信息和成本系统检索财务数据。
在 2014 年 4 月至 2020 年 3 月期间，232 名女性接受了即刻双侧（n=44）、分期单侧（n=57）或单侧乳房成形术（n=131）。与分期单侧乳房成形术相比，单侧乳房成形术加即时双侧乳房成形术的每位患者的额外费用中位数（四分位距（i.q.r.））为 5500 欧元（4330 至 6570 欧元）（P<0.001），这代表研究机构的总附加财务负担为 313462 欧元。各组之间的年龄、Charlson 合并症指数、手术时间、辅助放疗开始时间（以月为单位）或住院时间无显著差异。
同步双手术医生即时双侧 TM 可以安全地立即实现对称化，并且具有经济效益，不会延迟接受辅助治疗或增加术后发病率。
